Expanding Care Access: Mobile Health Units Delivering Diabetic Retinopathy Screening

Improving Access to Care with Mobile Health Screening Units

Mobile health screening units are large vans and buses equipped as roaming medical clinics that travel directly to underserved communities to provide free or low-cost preventative care services. With the passing of the MOBILE Health Care Act, congress has allowed federally qualified health centers more flexibility in creating and operating mobile health services. Once funded, the regulatory shift will allow health centers to collaborate with independent organizations that have relied on a mix of other federal and state grants to expand services in underserved regions. 45% of mobile clinics stay funded on the road with federal dollars, while philanthropy donations keep 52% running.

Mobile clinics commonly provide services like prevention checks, dental, primary, mammography, maternal and infant health, pediatric, asthma, mental health, disaster relief, and more. Establishing permanent rural clinics may not be cost-effective when mobile units can adequately serve small, scattered populations on a fraction of the budget. There is robust evidence that mobile clinics improve health outcomes and reduce costs to the health care system and to society-at-large.


Convenience & Accessibility

By traveling locally on a scheduled route, mobile health clinics eliminate transportation barriers and bring preventive services closer to where people live and work.  Mobile health programs allow health organizations to collect data on local care gaps and tailor routes to reach areas with high medical need.

They frequently serve rural regions and urban neighborhoods with limited healthcare access due to geographic isolation, provider shortages, lack of insurance coverage, or cost barriers. Mobile clinics operate in all 50 states, the District of Columbia, and Puerto Rico.


Affordability & Efficacy

Despite the initial investment, studies show mobile health programs provide overall cost-savings and positive return on investment. The average annual cost of operating a mobile health clinic is around $275,000. According to Mobile Health Map, for every $1 spent on mobile health, $12 is saved, resulting in a return on investment of 12:1. Reducing unnecessary ER visits is a powerful way that health systems can reduce costs. By understanding how mobile health care clinics affect the bottom line of healthcare organizations, more can be sustained or expanded to deliver their needed services.

By providing convenient and affordable screening services, mobile units facilitate earlier diagnosis and treatment of various medical conditions. For example, hypertension management is notoriously difficult for patients to adhere to, but mobile clinic programs were able to lower blood pressure and cholesterol levels with follow-up visits. A program in Louisiana saw some of their patients with diabetes lower their HbA1c levels by 20% or more.

Diabetic Retinopathy Screening

A key service provided by many mobile clinics is diabetic retinopathy (DR) screening. DR is a common microvascular complication of diabetes and the leading cause of preventable blindness among working-age adults. Clinical guidelines recommend annual dilated eye exams to check for signs of DR, but screening rates remain low with only 50-60% of individuals with diabetes adhering to regular exams.

Barriers to DR screening include lack of access to ophthalmologists and optometrists, cost of eye exams, inadequate time during primary care visits, reticence for dilation, and lack of patient awareness – with early stages being asymptomatic. Mobile screening units equipped with retinal cameras are helping to these obstacles to DR screening through community outreach.

Telemedicine programs for diabetic retinopathy screening capture retinal images in one location and assess them remotely, often making use of clinical encounters in non-ophthalmic settings like primary care clinics and have been very successful. A recent meta-analysis of large-scale studies revealed that tele-retinal imaging screening programs achieve high sensitivity (91%) and specificity (88%) in detecting threshold-level diabetic retinopathy, comparable to traditional clinical examination.

Achieving efficiency and scalability through a mobile, van-based system may offer the best means of obtaining the largest amount of screening images and data in the shortest amount of time. A mobile screening program can easily scale up to cover larger geographical areas with minimal additional resource expenditure, optimizing the schedule for a single camera and van to ensure full utilization throughout the week, where staff availability may be the limiting factor.

Studies demonstrate that adding DR telescreening to mobile health services improves screening compliance and detection of eye disease. A Los Angeles-based mobile health program reduced visits to specialty care professionals by 14,000, increased annual rates of screening for DR by 16.3%, and reduced wait times for screening by 89.2%.

Treating DR-associated pathology identified in tele-ophthalmology DR screening program in New York yielded a gain of 9 QALY and saved $49,052, with treatment generating $208,535 in revenue based on CMS reimbursement rates. Other studies suggest that tele-retina is a more cost-effective means of screening for diabetic retinopathy than the standard of care in urban and rural communities.


Integrating Handheld Fundus Cameras into Mobile Screening

Traditionally, bulky non-mydriatic tabletop retinal cameras have been used on mobile units for diabetic retinopathy screening. However, new handheld fundus cameras provide advantages that can optimize workflow and efficiency. The compact size of handheld cameras also enables flexibility for opportunistic screening. Staff can easily bring the camera into senior centers, schools, and workplaces that lack a dedicated exam room required for bulkier traditional cameras.

Handheld cameras like the Optomed Aurora IQ are lightweight, portable, and fast to operate – ideal qualities for a mobile setting. The intuitive design allows primary care staff with minimal training to quickly acquire high quality retinal images without pupil dilation. Good image quality is essential for good accuracy of screening results and, ultimately, the clinical value of the tools in use. Clinical and real-world studies have shown that the Aurora IQ is as effective as standard desktop fundus cameras in DR and diabetic maculopathy detection. Unlike most mobile phone-based handhelds, the Aurora IQ meets ISO 10940 standard quality for ophthalmic equipment.

Additionally, the lower cost of handheld fundus cameras compared to standard tabletop models reduces capital investment to equip a mobile unit. Price often prohibits obtaining more than one retinal camera, but multiple handheld units can be used simultaneously at different screening stations to increase capacity. Given its relatively low-cost, the mobile clinic model appears to be a sound economic complement to stationary healthcare facilities and pairs nicely with the affordable handheld fundus camera.

Introducing user-friendly handheld fundus cameras allows mobile clinics to provide more convenient, efficient, and widespread diabetic retinopathy screening. This technology implementation can optimize limited resources for underserved populations and lead to earlier diagnosis and prevention of blindness.

Let’s join forces to make screening easier and more affordable.

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