Community Eye Program Cuts Costs in Half Without Reducing Patient Care

Girl having her eyes tested.
A social worker eye care adherence intervention for underserved urban children has been revised to reduce costs, improve efficiency.

The revised iteration of a pediatric eye care program has reduced cost and social worker time per patient, according to findings published in the American Journal of Ophthalmology. The research evaluated the Children’s Eye Care Adherence Program (CECAP2) in Philadelphia, a social worker intervention targeted at underserved children.

The team behind the effort revised the original intervention program, CECAP1, using the data obtained from it, to reduce costs and increase effectiveness. Changes made included prioritizing children more likely to visit, decreasing scheduling attempts, better documenting children’s medical history, and constricting the geographic catchment area. The results of the study found that social worker time per patient was 0.8 hours for CECAP2, compared with 2.6 hours for CECAP1 (P <.01); cost per patient was $32.73, compared with the previous amount of $77.20 (P <.01); and the percentage of the 462 children referred to CECAP2 who completed recommended eye examinations was 52.4% (n=242), almost identical to the percentage in CECAP1 (52.3%). 

The study explains that social worker interventions such as CECAP can aid the families of underserved children in overcoming barriers such as cost, transportation issues, and conflicting family priorities, in favor of improving attendance at follow-up eye care. For this intervention, the children were referred from in-school and on-campus screening programs, which are accessible and convenient. Although CECAP1 drastically improved rates of follow-up with pediatric ophthalmologists compared with rates prior to the program’s implementation — from 5% to nearly 60% — the program was costly. For this reason, program sustainability was a priority in the modified CECAP2, with an emphasis on reducing social worker time, which was attributed to the majority of costs. Overall, the changes made to CECAP1 reduced costs by more than 50%.

Study limitations include its retrospective design. Also, the fact that CECAP2 focused on children who were statistically more likely to show up to appointments could have caused a decline of diversity in the study population. The researchers recommend putting an emphasis on reaching that group in future studies and programs.

“Although CECAP2 is more sustainable [than CECAP1], we do not recommend completely abandoning those children who are selected to be lost to follow-up,” the study explains. “Rather, it must be hoped that other interventions will continue to be tried to reach those children, at both the ophthalmic and school levels.”


Chung S, Snitzer M, Prioli K, et al., Reducing the costs of an eye care adherence program for under-served children referred through inner-city vision screenings. Am J Ophthal. Published online February 10, 2021. doi:10.1016/j.ajo.2021.02.012