Provider and Healthcare Administrator Survey on Diabetes-Related Kidney and Eye Disease

Purpose of Survey

Diabetes-related complications, such as nephropathy and retinopathy, can lead to severe health consequences, including kidney failure and blindness. Early detection of these complications through screening can reduce the associated risks, but data suggests that screening rates in Kentucky have room for improvement. Without proper screenings, diabetes-related complications can go undetected until they reach advanced, costly stages with potentially irreversible outcomes. Increasing screening rates can improve the incidence and severity of preventable kidney and eye diseases and enhance the quality of life for people with diabetes in Kentucky.

In response, the Kentucky Diabetes Prevention and Control Program within the Kentucky Department for Public Health (KDPH) and the Kentuckiana Health Collaborative (KHC) are partnering to develop an action plan to increase screening rates for kidney and eye disease among people with diabetes. This survey will inform the development of that action plan by assessing:

● Current practices in diabetes-related kidney and eye screening.
● Barriers/gaps that may exist that prevent people with diabetes from being regularly screened for kidney and eye disease.

Survey Participants
This survey is intended to reach healthcare providers or healthcare administrators. Respondents will be asked to identify their professional role in the survey. Other stakeholders interested in this topic can reach out to nmiddaugh@khcollaborative.org about participating on the Kentucky Task-Force for Diabetes-Related Kidney and Eye Disease.

Time to Complete Survey
This survey will take approximately 10-15 minutes to complete.

Incentive Disbursement
In appreciation for your time, participants who complete this survey will receive a $25 gift card.
To be eligible, you must complete the full survey and provide a valid mailing address at the end. Your responses will remain confidential and will only be used for research purposes.

Confidentiality
Unless voluntarily provided, no personally identifiable information is collected through this survey. All responses are anonymous. Information collected in the survey will only be reported in aggregate.

Section 1: Practice and Provider Characteristics

Question Title

* 1. What is your professional role?

Physician

Nurse Practitioner

Registered Nurse

Endocrinologist

Ophthalmologist

Optometrist

Nephrologist

Other (please specify)

Question Title

* 2. Which Area Development Districts (ADD) do you practice in throughout Kentucky? Select all that apply.

Northern Kentucky Area Development District (Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen and Pendleton counties)

Kentuckiana Regional Planning and Development Agency (Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer and Trimble counties)

Buffalo Trace Area Development District (Bracken, Fleming, Lewis, Mason, and Robertson counties)

FIVCO Area Development District (Boyd, Carter, Elliott, Greenup and Lawrence counties)

Gateway Area Development District (Bath, Menifee, Montgomery, Morgan, and Rowan counties)

Bluegrass Area Development District (Anderson, Bourbon, Boyle, Clark, Estill, Fayette, Franklin, Garrard, Harrison, Jessamine, Lincoln, Madison, Mercer, Nicholas, Powell, Scott, and Woodford counties)

Lincoln Trail Area Development District (Breckinridge, Grayson, Hardin, LaRue, Marion, Meade, Nelson, and Washington counties

Big Sandy Area Development District (Floyd, Johnson, Magoffin, Martin and Pike counties)

Kentucky River Area Development District (Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry, and Wolfe counties)

Pennyrile Area Development District (Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd and Trigg counties)

Barren River Area Development District (Allen, Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Monroe, Simpson, and Warren counties)

Lake Cumberland Area Development District (Adair, Casey, Clinton, Cumberland, Green, McCreary, Pulaski, Russell, Taylor, and Wayne counties)

Cumberland Valley Area Development District (Bell, Clay, Harlan, Jackson, Knox, Laurel, Rockcastle, and Whitley counties)

Purchase Area Development District (Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Marshall, and McCracken counties)

Green River Area Development District (Daviess, Hancock, Henderson, McLean, Ohio, Union and Webster counties)

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* 3. What healthcare setting do you practice in?

Primary Care Clinic

Federally Qualified Health Center

Hospital

Specialty Care Clinic

Other (please specify)

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* 4. Does the majority of your patient population represent any of the below populations? Select all that apply.

Black/ African American persons

Hispanic/ Latino persons

People aged 65 and older

People with lower incomes

People with lower education

People with food insecurity

People with low broadband access

* 10. Using the table below, indicate how influential you find the listed clinical-related barriers on your ability to screen for eye disease among patients with diabetes.

	Very Influential	Somewhat Influential	Not Influential
Low reimbursement rates from insurance providers	Low reimbursement rates from insurance providers Very Influential	Low reimbursement rates from insurance providers Somewhat Influential	Low reimbursement rates from insurance providers Not Influential
Unfamiliar with screening recommendations	Unfamiliar with screening recommendations Very Influential	Unfamiliar with screening recommendations Somewhat Influential	Unfamiliar with screening recommendations Not Influential
No standardized care protocol established in practice	No standardized care protocol established in practice Very Influential	No standardized care protocol established in practice Somewhat Influential	No standardized care protocol established in practice Not Influential
Difficulty coordinating care with other providers/specialists	Difficulty coordinating care with other providers/specialists Very Influential	Difficulty coordinating care with other providers/specialists Somewhat Influential	Difficulty coordinating care with other providers/specialists Not Influential
Lacking in referral opportunities	Lacking in referral opportunities Very Influential	Lacking in referral opportunities Somewhat Influential	Lacking in referral opportunities Not Influential
Difficulty with the Electronic Health Record (EHR) (i.e data flow, reminders, care documentation)	Difficulty with the Electronic Health Record (EHR) (i.e data flow, reminders, care documentation) Very Influential	Difficulty with the Electronic Health Record (EHR) (i.e data flow, reminders, care documentation) Somewhat Influential	Difficulty with the Electronic Health Record (EHR) (i.e data flow, reminders, care documentation) Not Influential
Billing Codes	Billing Codes Very Influential	Billing Codes Somewhat Influential	Billing Codes Not Influential
Difficulty in meeting staffing needs	Difficulty in meeting staffing needs Very Influential	Difficulty in meeting staffing needs Somewhat Influential	Difficulty in meeting staffing needs Not Influential

Other (please specify)

Question Title

* 11. Using the table below, indicate how influential you find the listed patient-related barriers on your ability to screen for kidney disease among patients with diabetes.

	Very Influential	Somewhat Influential	Not Influential
Out-of-pocket costs of tests	Out-of-pocket costs of tests Very Influential	Out-of-pocket costs of tests Somewhat Influential	Out-of-pocket costs of tests Not Influential
Nonadherence to screening recommendations	Nonadherence to screening recommendations Very Influential	Nonadherence to screening recommendations Somewhat Influential	Nonadherence to screening recommendations Not Influential
Lack of follow through with referrals	Lack of follow through with referrals Very Influential	Lack of follow through with referrals Somewhat Influential	Lack of follow through with referrals Not Influential
Social or environmental barriers	Social or environmental barriers Very Influential	Social or environmental barriers Somewhat Influential	Social or environmental barriers Not Influential
Difficulty with travel to referrals or follow-up appointments	Difficulty with travel to referrals or follow-up appointments Very Influential	Difficulty with travel to referrals or follow-up appointments Somewhat Influential	Difficulty with travel to referrals or follow-up appointments Not Influential
Avoidance of diagnosis and subsequent treatment	Avoidance of diagnosis and subsequent treatment Very Influential	Avoidance of diagnosis and subsequent treatment Somewhat Influential	Avoidance of diagnosis and subsequent treatment Not Influential

Section 5: Diabetes-Related Eye Disease Screening Barriers

Question Title

* 18. Using the table below, indicate how influential you find the listed clinical barriers on your ability to screen for eye disease among patients with diabetes.

	Very Influential	Somewhat Influential	Not Influential
Low reimbursement rates from insurance providers	Low reimbursement rates from insurance providers Very Influential	Low reimbursement rates from insurance providers Somewhat Influential	Low reimbursement rates from insurance providers Not Influential
Unfamiliar with screening recommendations	Unfamiliar with screening recommendations Very Influential	Unfamiliar with screening recommendations Somewhat Influential	Unfamiliar with screening recommendations Not Influential
No standardized care protocol established in practice	No standardized care protocol established in practice Very Influential	No standardized care protocol established in practice Somewhat Influential	No standardized care protocol established in practice Not Influential
Difficulty coordinating care with other providers/specialists	Difficulty coordinating care with other providers/specialists Very Influential	Difficulty coordinating care with other providers/specialists Somewhat Influential	Difficulty coordinating care with other providers/specialists Not Influential
Lacking of providers to refer people to for screening	Lacking of providers to refer people to for screening Very Influential	Lacking of providers to refer people to for screening Somewhat Influential	Lacking of providers to refer people to for screening Not Influential
Difficulty with the Electronic Health Record (EHR) (i.e data flow, reminders, care documentation)	Difficulty with the Electronic Health Record (EHR) (i.e data flow, reminders, care documentation) Very Influential	Difficulty with the Electronic Health Record (EHR) (i.e data flow, reminders, care documentation) Somewhat Influential	Difficulty with the Electronic Health Record (EHR) (i.e data flow, reminders, care documentation) Not Influential
Difficulty in meeting staffing needs	Difficulty in meeting staffing needs Very Influential	Difficulty in meeting staffing needs Somewhat Influential	Difficulty in meeting staffing needs Not Influential

Question Title

* 19. Using the table below, indicate how influential you find the patient-related barriers on your ability to screen for eye disease among patients with diabetes.

	Very Influential	Somewhat Influential	Not Influential
Out-of-pocket costs of tests	Out-of-pocket costs of tests Very Influential	Out-of-pocket costs of tests Somewhat Influential	Out-of-pocket costs of tests Not Influential
Nonadherence to screening recommendations	Nonadherence to screening recommendations Very Influential	Nonadherence to screening recommendations Somewhat Influential	Nonadherence to screening recommendations Not Influential
Lack of follow-through with referrals	Lack of follow-through with referrals Very Influential	Lack of follow-through with referrals Somewhat Influential	Lack of follow-through with referrals Not Influential
Social or environmental barriers	Social or environmental barriers Very Influential	Social or environmental barriers Somewhat Influential	Social or environmental barriers Not Influential
Difficulty with travel to referrals or follow-up appointments	Difficulty with travel to referrals or follow-up appointments Very Influential	Difficulty with travel to referrals or follow-up appointments Somewhat Influential	Difficulty with travel to referrals or follow-up appointments Not Influential
Avoidance of diagnosis and subsequent treatment	Avoidance of diagnosis and subsequent treatment Very Influential	Avoidance of diagnosis and subsequent treatment Somewhat Influential	Avoidance of diagnosis and subsequent treatment Not Influential

Other (please specify)

Section 6: Data & Recommendations

* 27. If you select either option, please provide your email address. Note that submitting your email address will make this survey submission no longer anonymous. Only project facilitators will see this information.

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* 28. If you select either option, please provide your name. Note that submitting your name will make this survey submission no longer anonymous. Only project facilitators will see this information.

Question Title

* 29. If you wish to receive a $25 incentive, please enter your full mailing address below.
(Your address will only be used to send your gift card and will not be linked to your survey responses.)

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Provider and Healthcare Administrator Survey on Diabetes-Related Kidney and Eye Disease

Question Title

* 1. What is your professional role?

Question Title

* 2. Which Area Development Districts (ADD) do you practice in throughout Kentucky? Select all that apply.

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* 3. What healthcare setting do you practice in?

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* 4. Does the majority of your patient population represent any of the below populations? Select all that apply.

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* 5. Do you or your practice use both estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) to screen people with diabetes?

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* 6. How often do you or your practice monitor kidney function in people with established CKD based on their risk classification?

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* 7. For people with type 1 diabetes, when do you or your practice initially screen for kidney function after their diabetes diagnosis?

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* 8. For people with type 2 diabetes, when do you or your practice initially screen for kidney function after their diabetes diagnosis?

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* 9. For people with type 2 diabetes, how often do you or your practice screen for kidney function after the initial screening?

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* 10. Using the table below, indicate how influential you find the listed clinical-related barriers on your ability to screen for eye disease among patients with diabetes.

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* 11. Using the table below, indicate how influential you find the listed patient-related barriers on your ability to screen for kidney disease among patients with diabetes.

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* 12. For Adults with Type 1 Diabetes:For people with type 1 diabetes, when do you or your practice initially screen or refer them for a dilated and comprehensive eye exam after their diabetes diagnosis?

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* 13. How frequently do you or your practice recommend dilated eye exams for adults with type 1 diabetes who have no evidence of retinopathy and whose glycemic indicators are within goal range?

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* 14. For people with type 2 diabetes, when do you or your practice initially screen or refer them for a dilated and comprehensive eye exam after their diabetes diagnosis?

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* 15. How frequently do you or your practice recommend dilated eye exams for adults with type 2 diabetes who have no evidence of retinopathy and whose glycemic indicators are within goal range?

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* 16. How frequently do you or your practice recommend dilated eye exams for people with progressing or sight-threatening diabetic retinopathy?

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* 17. Do you record the completion of a comprehensive eye exam after someone has been referred for it?

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* 18. Using the table below, indicate how influential you find the listed clinical barriers on your ability to screen for eye disease among patients with diabetes.

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* 19. Using the table below, indicate how influential you find the patient-related barriers on your ability to screen for eye disease among patients with diabetes.

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* 20. What data sources do you use to assess your practice’s screening rates for diabetes-related kidney and eye disease?

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* 21. How accurate and reliable do you feel that your current data sources are? Rate your response on a scale from 1-10, with 1 being not at all accurate and reliable and 10 being entirely accurate and reliable.

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* 22. What is one recommendation you have to improve screening for diabetes-related kidney disease?

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* 23. What is one recommendation you have to improve screening for diabetes-related eye disease?

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* 24. Is there anything else you would like to share regarding the topic of screening for diabetes-related kidney and eye disease?

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* 25. Who else should we talk with to learn more about the survey topic?

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* 26. Survey respondents will have the opportunity to indicate their interest in participating in two additional opportunities. Please select none, one, or both of the options below.

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* 27. If you select either option, please provide your email address. Note that submitting your email address will make this survey submission no longer anonymous. Only project facilitators will see this information.

Question Title

* 28. If you select either option, please provide your name. Note that submitting your name will make this survey submission no longer anonymous. Only project facilitators will see this information.

Question Title

* 29. If you wish to receive a $25 incentive, please enter your full mailing address below.(Your address will only be used to send your gift card and will not be linked to your survey responses.)

* 12. For Adults with Type 1 Diabetes:

For people with type 1 diabetes, when do you or your practice initially screen or refer them for a dilated and comprehensive eye exam after their diabetes diagnosis?

* 29. If you wish to receive a $25 incentive, please enter your full mailing address below.
(Your address will only be used to send your gift card and will not be linked to your survey responses.)