Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sharon E. Lock

Clinical Mentor

Angela Rayhill

Committee Member

Dr. Julie Ossege


Purpose: To evaluate the effects of a referral process on diabetic retinopathy screening rates among patients with Type 2 diabetes and formal documentation completion rates of these screenings within a primary care setting.

Methods: A referral process for patient referral to an ophthalmologist for annual diabetic retinopathy screening was instituted for a 4-week period within a Norton Community Medical Associates (NCMA) primary care location for Type 2 diabetes patients. Charts of 30 patients pre-intervention were compared with the charts of 30 patients seen during the intervention phase of the study to evaluate the effects of the referral intervention. Demographic data, including age, race, gender, and type of insurance, along with clinical data, including most recent Hgb A1C level, were collected for data analysis comparison.

Results: There was no statistically significant difference between the demographic and clinical data collected from the pre- and post-intervention groups. Additionally, the difference in referral rates and formal documentation rates for the two groups was not statistically significant (p > 0.05).

Conclusion: A process improvement project using a brief referral intervention in a primary care setting showed no effect. Further study into this type of intervention to increase diabetic retinopathy screening rates in Type 2 diabetes patients and formal documentation completion rates of these screenings may be more beneficial if performed over a longer study period with evaluation of barriers preventing success at set time points during the study.