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

Primary Hypothesis

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

Data Collection

  • 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

Outcomes and Measures

  • 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

Participating Health Systems

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
Brandon, VT

University of Rochester Medical Center

Marion, NY
Williamson, NY

Mountain Family Health Centers

Glenwood Springs, CO
Basalt, CO
Rifle, CO

Cultural Adaptations

Black Americans are more likely to develop diabetes and retinopathy leading to blindness, so adapting a teleophthalmology program is urgent. Black patients have unique barriers to seeking eye care and have greater healthcare mistrust compared to previously studied rural, white patients. Patient and clinician interviews aim to identify barriers to seeking care and  factors relating to medical mistrust. Identifying barriers will guide the development and testing of a culturally adapted I-SITE intervention to increase eye screening within urban, black patients