Multimodal Physician Intervention to Detect Amblyopia

Not Applicable

Completed

• Conditions: Amblyopia; Strabismus
• Interventions: Other: Pediatric blood pressure screening; Other: Pediatric vision screening

• Registration Number: NCT01109459
• Lead Sponsor: University of Alabama at Birmingham

Brief Summary

Current research shows low rates of quantitative vision screening at preschool ages in the medical home. This study targets providers (PCPs) to evaluate the effectiveness of a web-based intervention to improve knowledge about strabismus, amblyopia and preschool vision screening, to increase preschool vision screening rates, and to improve rates of diagnosis of strabismus and amblyopia by eye specialists.

Detailed Description

Despite decades of research showing adverse neural consequences of abnormal vision, little has changed for amblyopic children. Over the past 40 years, data have shown that most children with amblyopia are detected late. In our health care system, primary care physicians play a pivotal role in translating findings about amblyopia into practice. But, our experience with the Maternal and Child Health Bureau (MCHB) / NEI expert panel on Vision Screening in the Preschool Child and the MCHB/ American Academy of Pediatrics (AAP) Project Universal Preschool Vision Screening revealed that primary care physicians get very little training about amblyopia and risk factors. Consequently, many do not screen aggressively for these conditions.

The University of Alabama Departments of Optometry, Pediatrics and Continuing Medical Education, in collaboration Medicaid Agencies in Alabama, South Carolina and Illinois, have developed a novel, internet-based, multi-modal strategy to increase the understanding and recognition of amblyopia and its risk factors by pediatricians and primary care physicians in office based settings. We have designed a cluster-randomized, controlled clinical trial to test whether our intervention results in improved performance by "intervention" physicians compared to control physicians (exposed to a web-based intervention for pediatric blood pressure screening and adolescent chlamydia screening). Our design, along with pre / post-intervention and control / intervention performance measures, will evaluate changes in practice attributable to the intervention versus those occurring from other sources over time. Our final analysis will show whether preschool patients of intervention physicians are more likely to be identified with strabismus or amblyopia. This research forges a critical link between the truly phenomenal body of amblyopia research fostered by the NEI and the health care offered to American children.

Study Timeline

• Study Start: 2004-09
• Primary Completion: 2008-10
• Study Completion: 2008-10
• Status Verified: 2010-04
• Study First Submitted: 2010-04-21
• Study First Submitted QC: 2010-04-22
• Last Update Submitted: 2010-04-22
• Study First Posted: 2010-04-23
• Last Update Posted: 2010-04-23

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 136

Inclusion Criteria

• files Medicaid claims for at least 8 well child visits for children aged 3 or 4 years during one year,
• files claims under individual name,
• has internet access.

Exclusion Criteria

• files fewer than 8 Medicaid claims for well child visits for children aged 3 or 4 years old during one year,
• files claims under a clinic name,
• does not have internet access.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Pediatric blood pressure screening	Pediatric blood pressure screening	control
Pediatric vision screening	Pediatric vision screening	intervention

Primary Outcome Measures

Name	Time	Method
preschool vision screening by primary care providers	1 year	A rate: number of claims for preschool vision screening (using a billing procedure code) / number of claims for well child exams (another billng code). These procedure codes are filed by primary care providers (PCPs). Rates are determined for individual Intervention, Control and non-participating eligible PCPs.

Secondary Outcome Measures

Name	Time	Method
Diagnosis of strabismus or amblyopia by eye specialists	1 year	A rate: number of claims from eye specialists with procedure codes of strabismus or amblyopia(using billing data) / number of claims for well child exams by intervention, control and non-participating eligible PCPs.

Trial Locations

Locations (1)

University of Alabama at Birmingham; 🇺🇸 Birmingham, Alabama, United States