I-TRUST

Overview

I-TRUST (Implementation of Teleophthalmology in Rural Health Systems) is a study testing I-SITE in 8 rural health systems across the U.S. From our previous studies, I-SITE sustained a 36% screening increase over two years at Mile Bluff (Mauston, WI). Through testing I-SITE at 8 sites, we hope to identify barriers in teleophthalmology use, tailor implementation strategies to these specific barriers, and use rapid-cycle testing of strategies to integrate teleophthalmology into daily primary care workflows.

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  1. Test the effectiveness of I-SITE (Implementation for Sustained Impact in Teleophthalmology)
  2. Identify key factors that distinguish high and low teleophthalmology
  3. Determine I-SITE implementation costs from a healthcare perspective

I-SITE will sustain diabetic eye screening rate increases compared to usual teleophthalmology care.

  • Monthly reports on teleophthalmology use
  • Interviews (pre- and post- I-SITE adoption) with clinic personnel
  • Clinic personnel activity logs to track activities and to assess health system cost

  • Change in screening rate between baseline and 24 months
  • Change in monthly teleopthalmology use
  • Follow-up rates from eye care among positive screens
  • Identify patient characteristics associated with teleophthalmology and follow-up care
  • Cost analysis, tracking time spent by clinical personnel and I-SITE Coaches

Fort Healthcare

  • Fort Atkinson, WI
  • Lake Mills, WI
  • Whitewater, WI

Reedsburg Area Medical Center

  • Reedsburg, WI

Ohio State University

  • Lewis Center, OH
  • Worthington, OH

Porter Medical Center/ University of Vermont

  • Vergennes, VT
  • Middlebury, VT
  • Brandon, VT

University of Rochester Medical Center

  • Marion, NY
  • Williamson, NY

Mountain Family Health Centers

  • Glenwood Springs, CO
  • Basalt, CO
  • Rifle, CO

Univ. of Alabama-Birmingham

  • Selma, AL

Cahaba Medical Care

  • Centreville, AL

CommuniCare+OLE /Univ. of California, Davis

  • Woodland, CA

Ascension

  • Centerville, TN

Cultural Adaptations

Black and Latinx communities are more likely to develop diabetes and retinopathy leading to blindness, so adapting a teleophthalmology program is urgent. Both Black and Latinx patients face unique barriers such as medical mistrust, systemic inequities, and language barriers. Patient and clinician interviews aim to identify barriers to care, communication needs, and factors contributing to medical mistrust. Identifying barriers will guide the development and testing of a culturally adapted I-SITE intervention to increase eye screening among urban Black and Latinx populations.

Partner Clincs

We are currently partnering with two qualified health centers to adapt and test the I-SITE intervention for Black and Latinx populations:

  • Outreach Community Health Centers – Milwaukee, WI
  • Access Community Health Centers – Madison, WI