A quality improvement project to increase compliance with diabetes measures in an academic outpatient setting

Abstract

Background American Diabetes Association (ADA) sets annual guidelines on preventative measures that aim to delay the onset of severe diabetes mellitus complications. Compared to private internal medicine clinics, resident clinics provide suboptimal diabetic preventative care as evidenced by decreased compliance with ADA guidelines. The purpose of our study is to improve diabetic care in resident clinics through quality improvement (QI) projects, with A1C value as primary outcome and other ADA guidelines as secondary outcomes. Methods Our resident clinic at Beaumont Hospital, Royal Oak consists of 76 residents divided in 8 teams. In November 2016, baseline data on ADA guideline measures was obtained on 538 patients with diabetes mellitus. A root cause analysis was conducted. 5 teams developed a QI intervention plan to improve their diabetes care and 3 teams served as comparisons without intervention plans. In November 2017, post-intervention data was collected. Results Baseline characteristics demonstrate mean age of intervention groups at 60.9 years and of comparison groups at 58.9 years. The change in A1C value from baseline to post-intervention was + 0.09 vs. + 0.322 in the intervention and comparison groups respectively ( p = 0.174). As a group, the changes in secondary outcome measures were as follows: eye examinations (+ 5% in intervention vs. -7% in comparison, p < 0.01), foot examinations (+ 13% vs. + 5%, p = 0.09), lipid panel testing (+ 7% vs. -5%, p < 0.01), micro-albumin/creatinine ratio testing (+ 4% vs. + 1%, p = 0.03), and A1C testing (+8% vs. + 5%, p = 0.24). Conclusions While the QI project did not improve A1C value, it did have significant improvement in several secondary outcomes within intervention groups. One resident team implemented an intervention involving protected half-day blocks to identify overdue examinations and consequently had the largest improvements, thus serving as a potential intervention to further study. Given our study results, we believe that QI interventions improve preventative care for patients with diabetes in resident clinics. Electronic supplementary material The online version of this article (10.1186/s40842-019-0084-9) contains supplementary material, which is available to authorized users.

Survival of children and youth with type 1 diabetes mellitus in Tanzania

“…38 The increasing diagnosis and likelihood of survival in the last cohort (2010-2019) is linked to the provision of optimal care as one of the major contributors to improving survival, as seen in other countries. 20,25 This also shows that the implemented programs have improved knowledge of the health care providers and the community, a finding similar to that of Edupungati et al (2019), 39 which is why there was an increase in diagnoses from 2011-to 2019. However, there are other factors like poverty that still prevent better survival.…”

Screening for Nephropathy in Pediatric Type 2 Diabetes: Quality Improvement to Increase Nephropathy Screening

“…Therefore, completion depends partly on the patients. This is a known barrier to QI interventions with diabetes screening, 23 and will require interventions that lessen the burden on patients outside of clinic visits by improving coordination with primary care and advocating for insurance changes to support patient needs. Another limitation is that there is no control group for comparison as these QI interventions were rolled out to all patient visits.…”

Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback

“…Despite these ACGME requirements and benefits, there is limited literature describing interprofessional QI projects with residents and even less literature where residents take a leadership role in an interprofessional team 17–20. Furthermore regarding diabetes, there are published reports describing resident QI projects for diabetes management, yet they are solely in the outpatient setting 21–23…”

“…[17][18][19][20] Furthermore regarding diabetes, there are published reports describing resident QI projects for diabetes management, yet they are solely in the outpatient setting. [21][22][23] A call to action from the American Diabetes Association states studies are needed to promote inpatient scheduled insulin, educate providers and change prescribing behaviour. 24 Healthcare organisations employ various methods to enhance adherence to medical practice guidelines, and one such approach is the utilisation of audit and feedback.…”