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Background:  Teleophthalmology is a validated method for diabetic eye screening that is underutilized in U.S. primary care clinics. Even when made available to patients, its long-term effectiveness for increasing screening rates is often limited.  Introduction:  We hypothesized that a stakeholder-based implementation program could increase teleophthalmology use and sustain improvements in diabetic eye screening.  Materials and Methods:   We used the NIATx Model o test a stakeholder-based teleophthalmology implementation program, I-SITE at one primary care clinic (Main) and compared teleophthalmology use and diabetic eye screening rates with those of other primary care clinics (Outreach) within a U.S. multipayer health system where teleophthalmology was underutilized.   Results:   Teleophthalmology use increased post-I-SITE implementation (odds ratio [OR] = 5.73 [ p &lt; 0.001]), and was greater at the Main than at the Outreach clinics (OR = 10.0 vs. 1.69, p &lt; 0.001). Overall diabetic eye screening rates maintained an increase from 47.4% at baseline to 60.2% and 64.1% at 1 and 2 years post-I-SITE implementation, respectively ( p &lt; 0.001). Patients who were younger (OR = 0.98 per year of age, p  = 0.02) and men (OR = 1.98, p  = 0.002) were more likely to use teleophthalmology than in-person dilated eye examinations for diabetic eye screening.   Discussion:  Our stakeholder-based implementation program achieved a significant increase in overall teleophthalmology use and maintained increased post-teleophthalmology diabetic eye screening rates.  Conclusion:  Stakeholder-based implementation may increase the long-term reach and effectiveness of teleophthalmology to reduce vision loss from diabetes. Our approach may improve integration of telehealth interventions into primary care.

Sustaining Gains in Diabetic Eye Screening: Outcomes from a Stakeholder-Based Implementation Program for Teleophthalmology in Primary Care