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Increasing Diabetes Education Referral Rates Using E-referrals in Primary Care

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Nguyen, Tien T.
Date
2023-05
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DNP Project
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Problem: Diabetes self-management education and support (DSMES) is an essential component to optimal care of Type 2 diabetes mellitus (T2DM) in patients. DSMES is associated with improved glycemic control, lower hemoglobin A1C, reduced morbidity and decreased financial burden. The Healthy People 2030 has set a goal of less than 11.6% of the population to have an A1C of above 9%. A 2021 chart audit at a primary care clinic showed 60-70% of patients with T2DM had hemoglobin A1C of > 9% with referral rates to registered dietitians (RD) for DSMES education at < 1.6%. Purpose: The purpose of this quality improvement initiative was to implement an e-referral process into the Electronic Health Record (EHR) to increase screening and referral rates to DSMES in patients with T2DM. Methods: Project implementation took place over a 15-week period in the Fall of 2022 at a two-provider, private, primary care practice. An electronic DSMES directory was developed, and an e-referral template integrated into the EHR. Providers and clinic staff were trained on screening and referral of patients with T2DM for DSMES. Results: 48.3% of all eligible patients were screened. Screening rates increased from 0% at baseline to 33.3%-78.6%. By the end of the implementation project, approximately 9.2% of eligible patients had been referred to DSMES programs. Conclusions: This finding is consistent with prior research studies conducted on similar interventions in primary care settings. Integrating standardized e-referral template into the EHR increased screening and referral rates of patients with T2DM. In addition, promoting providers awareness and understanding about DSMES programs increases the likelihood of screening and referral rates to these programs.

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