189 - Impact of telemedicine in retinopathy of prematurity screening in a level II neonatal intensive care unit in southwest Oklahoma - a 6-year experience.

Publication Number: 189.5118

Trassanee Chatmethakul, OUHSC, Oklahoma City, OK, United States; Abhishek Makkar, University of Texas Southwestern Medical School, Dallas, TX, United States; R. Michael M. Siatkowski, Dean McGee Eye Institute/University of Oklahoma, Oklahoma City, OK, United States; Jennifer Milam, Oklahoma Childrens Hospital at OU Health, Blanchard, OK, United States; Lauren Ciambrone, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States

Background: In 2013, Comanche County Memorial Hospital (CCMH) in Lawton in collaboration with University of Oklahoma Medical Center (OUMC) established a level II neonatal intensive care unit (NICU) utilizing hybrid telemedicine model. Located 87 miles southwest of Oklahoma City, CCMH NICU began offering telemedicine for retinal imaging (Tele-ROP) in July 2017. This service has since enabled premature infants at lower risk for ROP to be able to receive both intensive care and ROP screening closer to home. Our study aims to evaluate the impact of the Tele-ROP program.

Objective: To evaluate feasibility, safety and cost effectiveness of utilizing telemedicine for ROP screening of infants at a satellite level II NICU.

Design/Methods: This retrospective study evaluated use of Tele-ROP screening in infants transferred from OUMC Level IV NICU to CCMH level II NICU between July 2017 and December 2023. The inclusion criteria were infants meeting AAP criteria for Level II NICU care. Infants with severe ocular or major congenital anomalies, or more severe ROP, were excluded. The study analyzed patient demographics and ROP examination findings from three time points, capturing 12 images per patient per exam. These images were graded by an ophthalmologist as Excellent-Good, Fair, or Poor. The correlation between tele-ROP and conventional ROP exams was assessed. Cost savings and reduction in parental financial burden was calculated. Descriptive statistics were computed for demographic and clinical variables.

Results: Over a 6-year period, 83 patients were transferred to CCMH level II NICU due to availability of Tele-ROP program. Telemedicine retinal image evaluation was utilized in 55 patients resulting in a total of 816 images captured. 98.2% of the images were graded as Good/Excellent, 1.8% as Fair, and 0% as Poor. No patients required referral for ROP, and no complications were reported. Tele-ROP program enabled families to spend 1157 additional patient hospital days in a NICU closer to home. Given the differential of $500 per day of hospital cost between the two NICUs, this program has resulted in approximately $578,000 hospital cost savings. Moreover, for fuel price of 3.1 dollars/gallon with 25 mpg car, a round trip from Oklahoma City to Lawton would cost at least 21.4 dollars. This allowed for reduction of parental financial burden thus improving health care accessibility and fostering family centered care.

Conclusion(s): Telemedicine for retinopathy of prematurity screening in a hybrid Level II NICU is safe, feasible, and enhances healthcare affordability and access in underserved areas.