Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Michael Moon


Jesus A. Yanes, III


Diabetic retinopathy is the most common microvascular complication associated with poorly controlled diabetes. Yet, only 60% of the diabetic population receives an annual eye examination by an eye specialist. Retinal imaging increases surveillance of retinopathy, however, it does not take the place of a comprehensive eye examination by an ophthalmologist or optometrist. The aim of this quality improvement project was to increase comprehensive eye examinations in patients with diabetes aged 18 to 75 years in a family practice that recently purchased a retinal imager. This quality improvement project occurred over a 10-week period. Project objectives included increasing comprehensive dilated eye examinations in diabetic patients, provider referral rates to eye specialists, and patient adherence to eye specialist referrals. Interventions included an educational session, diabetes eye exam checklist, patient reminder card, electronic medical record alert, and an informational brochure for patients to take home. After 10 weeks, the eye examination rate for patients with diabetes at the family practice increased from 45% to 63% and 67 new referrals were sent to eye specialists by providers. Providers at the clinic with the retinal imager were less likely to send out referrals. Lastly, patients who received reminder cards had an 85% adherence rate to referrals. The use of a checklist and an electronic alert increases provider referral rates to eye specialists, while a reminder card increases patient adherence to referrals. However, the presence of a retinal imager in a clinic reduces the likelihood that a patient will receive a referral to an eye specialist.