Improving State-Level Surveillance by Integrating Health Data Collection
Ohio established surveillance of vision health at both the individual and population levels by integrating data on vision screening, eye examination, and treatment outcomes into its state immunization information system (ImpactSIIS, https://odhgateway.odh.ohio.gov/impact/). The Ohio Department of Health (ODH) developed a security protocol for all individuals authorized to access the vision health module, as well as training programs, staffing support, and internal data entry/analysis systems. All screening sites (including primary care, early education/Head Start, community screening programs, public health clinics) submit vision screening and referral data to the system via direct data entry or by uploading a separate data reporting file. Eye care providers in the state also have access to the data entry system, allowing them to submit examination outcomes and treatment recommendations.
This multi-stakeholder effort has yielded multiple achievements:
Efforts to further develop and improve the system are ongoing. Ohio’s Title V Maternal and Child Health program incorporated vision screening into one of its ten State Performance Measures, annually tracking the “percent of children who receive timely, age-appropriate screening and referral.” A broad set of stakeholders contributes to system improvement through engagement in needs assessments, workgroups, and other advisory mechanisms.
Improving Annual Vision Screening Rates across a Pediatric Primary Care Network
Recognizing the importance of vision screening for preschool-age children, the Pediatric Physicians’ Organization at Children’s (PPOC, Boston Children’s Hospital), one of the largest pediatric primary care physician organizations in the country, implemented a rigorous quality improvement process to improve screening rates in their network.
The PPOC, which cares for over 400,000 children at more than 90 primary care locations throughout Massachusetts, provided system-wide training and supported the development of practice-specific quality improvement cycles (Plan-Do-Study-Act) to improve vision screening processes and completion rates. Referrals for eye exams are now considered “critical referrals”; practices track them from initiation through closure communication with specialty care providers. Practices work closely with families to schedule comprehensive eye exams and ensure the exams have been completed.
Among the 34 practices that participated in the initial phase of this quality improvement effort, acuity screening increased from 25 to 31 percent for 3-yearolds, from 50 to 56 percent for 4-year-olds, and from 59 to 65 percent for 5-yearolds. Ocular alignment screening increased from 23 to 27 percent for 3-year-olds, from 42 to 44 percent for 4-year-olds, and from 44 to 50 percent for 5-year-olds. Efforts to further improve screening rates are ongoing, including additional training and consideration of new technologies for vision screening in young children.
Increasing Provision of Preventive Health Services Through Changes in the Payment System
Arizona leveraged a proposed change in Medicaid payment policy, along with strong philanthropic support for screening in primary care settings, to create rapid improvement in the rates and quality of vision screening for young children. A large health foundation in the state convened key stakeholders to coordinate systems and resources to move the work forward.
Approximately 40 percent of Arizona children are enrolled in health insurance through Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid agency. The change in AHCCCS policy allows payment for instrumentbased pediatric vision screening (ocular photoscreening) for children ages 3 to 5 years. Payment is limited to one occurrence in a lifetime, and the screening must occur in conjunction with a well-child medical visit. This new payment provides an incentive for primary care practices to purchase and use vision screening devices, the costs of which previously have been a barrier to acquisition. Additionally, the billing CPT code (99174 or 99177)can be used as a process measure indicating rate of screening in this population, ultimately driving further practice improvements for children’s vision and eye health.