Date of Award


Document Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Andy Coburn, PhD


diabetes, dilated eye exams, exam completion rates, Maine, health care cost, health care value, Muskie School of Public Service


This capstone project was designed to understand and analyze the completion rates for diabetic dilated eye exams within four different health systems participating in the MaineHealth Accountable Care Organizations (ACO). This research is valuable within the current US health care climate as health care providers have sought to evaluate the cost of care in terms of their value to payers. Moreover, many providers have elected to join the ACO in order to demonstrate better outcomes, improve the cost of care and to share programmatic content and tools to standardized care. Within this capstone, system level workflows and processes were evaluated to better identify the factors that hindered eye exam completion rates. These factors included both operational and patient-specific barriers that appeared to negatively impact rates of completion. Workflows and processes were also evaluated with the intention of identifying strategies that were positively influencing rates and that could be replicated in others health systems. Other areas of focus were in understanding what other ACO’s had developed as strategies to as well as what approach commercial payers such as Anthem to mitigate the impact of these factors. Lastly, additional supports that can be provided by the ACO to mitigate the impact of these factors were proposed.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.