 For data analysis purposes, there will be two sets of inclusion criteria ? EPRP visit criteria and diabetes identification criteria. To be included in the primary data analyses a patient must meet the criteria of the Office of Quality Performances quality monitoring program. This criteria includes at least one outpatient visit during the current fiscal year and at least one outpatient visit in the fiscal year prior to the current year see The previous and current qualifying visits must be in any one of 8 clinics Primary Care 301, General Medicine 323, Cardiology 303, EndocrinologyMetabolism 305, Diabetes 306, Hypertension 309, PulmonaryChest 312, or Womens Health 322 per the West Virginias Peer Review Organizations External Peer Review Program EPRP selection criteria. Eligible patients would be excluded if they had a life expectancy of 6 months or less e.g., diagnosis of pancreatic cancer or in hospice. For epidemiological comparability, separate cohorts will be constructed for evaluating eye care at the beginning of the study period for the pre-intervention analyses and at end of the study period for the post-intervention analyses. We will identify diabetics for analytic purposes by requiring them to meet one of the following criteria in the previous year: 1 one or more prescriptions filled for hypoglycemic medications or self-monitoring blood glucose supplies as determined by VISTA records, 2 having a diagnosis of diabetes ICD-9 250.x recorded in at least 2 separate outpatient encounters, or 3 having a diagnosis of diabetes recorded for one or more inpatient stays. 