Date of Award

2022

Embargo Period

1-1-2023

Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Annie N. Simpson

Second Advisor

Kit N. Simpson

Third Advisor

Jillian B. Harvey

Abstract

Objective: The aim of this study is to identify factors associated with loss to follow-up (LTFU) in patients receiving treatment for proliferative diabetic retinopathy (PDR). The current study seeks to characterize the proportion of patients with PDR who were LTFU in clinical practice and to evaluate potential factors related to LTFU. Methods: A Retrospective study utilizing a 5% sample of Medicare claims data between 2017-2019 was conducted to determine risk factors associated with LTFU in PDR patients who have received at least one anti-endothelia growth factor injection (VEGF). Descriptive statistics was performed to compare PDR patients who are and are not LTFU. Mean and standard deviations were used to describe continuous independent variables and counts, and percentages were reported for categorical data. Generalized linear models with poisson distribution and log Link were performed to estimate the relative risk of being LTFU. Results: The study found that both 6-Month (84.0%) and 12-Month LTFU (73.0%) rates were exceedingly high for patients who have received at least one VEGF for PDR from 2017-2019. A total of 551 patients in whom PDR was diagnosed met the criteria. When examining the factors associated with 6-month and 12-month LTFU, age, sex, and race were not statistically significantly predictive. However, with every 100 days those patients remain in treatment, the relative risk decreased by 7% (6-month LTFU) and 8% (12-month LTFU). Among patients who died during follow up, their relative risk decreased by 42.8% (6-month LTFU) and 67.7% (12-month LTFU) than those who did not die (p-value < 0.0001). The relative risk increased both at 6-month LTFU (20.8%) and 12-month LTFU (35.9%) for those who had more than 5 treatment injections. We also saw the relative risk increased by 11.8% in those who had dual eligibility during 12-Month LTFU but was not statistically significant in patients that were 6-months LTFU. Conclusion: This study highlights some new insights into this cohort, but additional questions remain, and future studies should be performed to investigate reasons for LTFU in this patient population related to comorbid disease, severity of vision loss, and psychological factors potentially related to LTFU for which this study was unable to address.

Rights

All rights reserved. Copyright is held by the author.

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