Abstract
Background: In reviewing first quarter clinical quality metrics in 2006, the primary care department at the Merrill Center identified a statistically significant drop in glycemic control for their diabetic population that did not occur across the clinic system-wide. Quality improvement changes were implemented from mid 2006 through mid 2007.
Aim: To increase glycemic control more than 50% over 12 months as evidenced by the percentage of patients with diabetes having most recent A1c test results <7%.
Methods: The system-wide quality improvement initiative increased provider awareness and educated providers on the need to improve clinical outcomes for patients with diabetes. Providers partnering with nurse educators resulted in increased referrals to the Diabetes Self Management program. Diabetes educators intensified insulin dosing for patients with uncontrolled blood sugars through use of a standard protocol. In addition to expanding existing diabetes services and hours, telephonic care management was initiated for high risk patients.
Implementation: An electronic medical record (EMR) and tablet computers improved the information that providers and other members of the care team could use to access at the point of service. An electronic reminder system helps identify patients not at goal requiring further testing, education, or medical intervention. A process for gathering outside A1c test results improved the coordination of diabetes care across health care facilities.
Results: Glycemic control as evidenced by the percentage of patients with most recent A1c test results <7% rose from 41% in second quarter of 2006 to 68.2% in third quarter of 2007 for the more than 800 patients with diabetes.
Conclusions: To improve quality of care, provider awareness and support are essential in developing a comprehensive diabetes program. Increased provider awareness, supported by an EMR has built a team approach to education, medical management, and care coordination resulting in improved glycemic control.
- Received September 11, 2008.
