Know Your Pressures NYC

Adherence to the Initial In-Office Appointment for those Referred to Ophthalmology and/or Primary Care (Implementation Outcome)

The primary implementation outcome measure for Aim 1 is ADHERENCE TO INITIAL IN-OFFICE APPOINTMENT FOR THOSE REFERRED for follow-up and will be measured by attendance at the initial in-office appointment. The initial in-office appointment will be scheduled by the study team at the conclusion of the BP/glaucoma screening. A comparison will be made between participants living in the 10 developments randomized to the Virtual Automated Intervention Arm compared to 4 developments randomized to Usual Care Arm.

Detection of undiagnosed and/or uncontrolled hypertension and/or glaucoma/suspect for those Referred to follow-up confirmed by in-office eye exam (Clinical Effectiveness Outcome)

The primary clinical effectiveness outcome measure for Aim 2 is detection of undiagnosed and/or uncontrolled HTN and/or glaucoma/suspect confirmed by in-office exams and will calculate the proportion of referred participants who attend and are newly diagnosed and/or treated for uncontrolled HTN and/or glaucoma/suspect in the office over 1 year. Uncontrolled BP is defined as \>130/80 mmHg and uncontrolled glaucoma/suspect is defined as IOP \>24 including an abnormal optic nerve photograph or OCT image. We will compare the proportion of participants by arm with newly diagnosed and/or uncontrolled HTN and/or glaucoma/suspect in the office over 1 year. Participants who request their own eye doctor will be encouraged to make an appointment as soon as possible. These individuals will be excluded from the Outcome analysis for Aim 2.

Follow-up Adherence to Recommended In-office Exams at 1-3 Years (Secondary Implementation Outcome)

A secondary maintenance measure is follow-up adherence to recommended in-office appointments for those who are referred and attend the initial appointment to assess access to care sustainability at 1-4 years. Adherence will be assessed annually on the basis of the expected follow-up schedule defined at the index visit for that year if the participant attends. In the first year, the follow-up recommendation given by the primary care provider and/or the ophthalmologist will be classified into 1 of 4 categories: return within 2 months, return in 3 to 4 months, return in 6 months, or return in 12 months. This follow-up recommendation will be translated into the corresponding expected number of visits per year: 6, 3, 2, or 1.

Return Attendance at Blood Pressure/Glaucoma Screenings at 1-3 Years (Secondary Implementation Outcome)

All participants will be invited to return to the BP/eye health screenings at 1, 2, and 3-year follow-up intervals to repeat the BP/glaucoma screening. We hypothesize that participants will return at various intervals (1, 2, and/or 3 times) and we want to understand the demographics and clinical characteristics of these participants as well as the frequency of attendance and why they returned and compare to those who did not elect to participate again. The intervals will be 1,2, and 3 years and we will measure the number and percentage of participants who attend the screenings over 4 years.