Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sharon Lock

Clinical Mentor

Dr. Michelle Campbell

Committee Member

Dr. Nancy Kloha



Background: Approximately 5.3 million Americans, aged 18 and over, carry a diagnosis of diabetic retinopathy (DR). By the year 2050 this number is expected to triple without effective healthcare intervention. Approximately 4.8% of the global blindness is attributable to DR, a silent, progressive, microvascular complication of diabetes. Best practice dictates immediate screening at time of diagnosis of Type II Diabetes Mellitus (T2DM) and biennial screenings thereafter, yet this need is often unmet.

Purpose: This study is a continuation of a process put into place by Dr. Michelle Campbell in October 2017 at the Norton Community Medical Associates Mount Washington practice and was to determine effectiveness of this intervention. This intervention involved formal referral with a specific form documenting the results of the ophthalmological screening being faxed back to the primary care office and scanned into the patient’s electronic health record (EHR).

Methods: This study used a retrospective chart review for the period 1 January 2017 to 1 May 2017 and 1 January 2018 to 1 May 2018 to determine the number of formal referrals to ophthalmology pre- and post-implementation as well as the number of formal documentation forms received during both time periods. Inclusion criteria included T2DM, ICD-10 codes E11.0-E11.9, and ages between 18 years and 70 years. One hundred charts were selected by the Information Technology Department for both pre- and post-implementation review.

Results: SPSS Software was used to analyze the data. A chi square test was used to measure these results. Pre- and post-implementation referrals yielded a p-value of 0.321 which was not statistically significant; however, pre- and post-implementation documentation yielded a p-value of .016 which was significant, unfortunately in the opposite direction than was hoped.

Keywords: Diabetic Retinopathy (DR), Electronic Health Record (EHR), Type II Diabetes Mellitus (T2DM)