Community & Home Eye Screening Service (CHESS)

CHESS was launched in February 2017 to address the problems of eye care inaccessibility to the elderly residents, delayed diagnoses and management of eye diseases. Novel teaching methods were implemented to rapidly heighten community nurses’ eye screening skills. Ground breaking innovations were introduced to evolve CHESS further. It is a cost-effective eye care model that has detected a significant number of asymptomatic eye conditions and has reduced the need for specialist referrals.

Innovation Summary

Innovation Overview

Project Background
Regular mass untargeted eye screenings do not reach the appropriate vulnerable populations in the community, especially the elderly, uneducated and frail. In order to address this gap, the Community & Home Eye Screening Service (CHESS) was launched in February 2017.

The team identified that mass community eye screenings were done infrequently since they are is labour-intensive. The projected manpower for a 300-patient community eye screening is about 30 staff (6 eye doctors, 6 optometrists, 6 nurses, and 12 patient service associates). It also involves the coordination of multiple resources such as manpower, eye equipment (reliance on vendors to support) and participants (dependence on the community partners to publicise and recruit).

Nevertheless, seniors in the community need to receive timely treatment to improve outcomes. As such, they need to have easy access to community eye care where the early detection of eye conditions can be achieved. To provide community eye screening services, several innovative projects were developed to upkeep CHESS.

Strategy for Change
CHESS was developed to provide First-level Community Eye Screening (FiLCES) and Second-level Eye Consultation Team (SeLECT) for early detection and management of treatable eye conditions that are accessible to Singapore residents who live in the north.

FiLCES involves the detection of functional decline in vision through various screening tests. These tests are performed by trained nurses and healthcare assistants from the Population Health & Community Transformation (PHCT) team. Seniors who fail the test are referred to SeLECT eye screening for further visual testing. SeLECT is performed by a trained optometrist. The optometrist also corresponds with an ophthalmologist through Tele-consult.

A pilot project was carried out from May – June 2016 to set the baseline data. It showed that 40.3% (52/129 patients) diagnosed to have one or more eye conditions at FiLCES.

A trans-disciplinary collaboration involving the various departments led to the innovation of a new care model with the following goals:
* To increase accessibility of community eye care using trained nurses & optometrists.

* To be cost effective by leveraging on existing resources and optimising usage of the resources.

* To train & accredit the nurses from Ageing-In-Place (AIP) & Population Health Program (PHP) to perform FiLCES with a novel teaching methodology:
- CHESS training curriculum comprised of lectures & hands-on training. Module 1 covers Visual Acuity Testing (VAT) & Intra-Ocular Pressure Measurement (IOPM). Module 2 covers the Torchlight Eye Screening Test (TEST) which is taught using a self-developed, innovative e-learning platform –TEACHES-LEM (Training enhancement and accreditation for Community and Home Eye Screening – Learning Electronic Module).
- The newly developed accreditation exam, Eye Screening Skills for Eye Nursing Competency Examination (ESSENCE), which requires a passing score of at least 80% (32/40) required for accreditation.
-A low-cost clinical examination tool (a visual guide for TEST) was developed in-house to aid the nurses in their clinical practice during eye screening.

*To train & accredit the optometrists to perform SeLECT under an Ophthalmologist’s supervision via tele-medicine using TigerConnect.

Benefits
CHESS managed to detect the top 5 eye abnormalities such as poor vision, eyelid position abnormalities, conjunctiva abnormalities, Amsler chart abnormalities and lens abnormalities. CHESS achieved its objective of providing easy access to community eye care, and contributing to the management of uncomplicated eye conditions in the community. This reduced the need for hospital referrals.

Besides providing care in the community, CHESS also introduced an innovative smart phone application known as Macular Amsler Testing Application (MATA). It was developed to allow sustainable self-monitoring by at-risk seniors. This eye scanning interface detects if the correct eye is being covered as well as ensures that the working distance of the chart to the patient’s eye is correct. The App features several step-by-step menus with instructional videos to engage the patient and help them navigate through the Amsler test correctly. The App is available for download via both Play Store and App Store for patients to monitor themselves using their own phone/tablet.

Scaling up
The team realised that one of the common causes of vision loss, known as glaucoma, which is often asymptomatic in the early stages, can be better screened by improving CHESS. The CHESS team comprising of optometrists & ophthalmologists, PHCT nurses & operations staffs collaborated to develop Glaucoma Community-based Augmented Review and Empowerment (G-CARE).

Besides G-CARE, the team is currently in the early stage discussion on Retina CARE using Optical Coherence tomography (OCT) machine. The team would subsequently move up to Anterior Segment CARE.

Innovation Description

Innovation Development

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Year: 2017
Level of government: Other

Status:

  • Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways

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