Screening for Diabetes-Related Distress in an Outpatient Endocrine Clinic

Abstract

Problem: Identification and treatment of diabetes-related distress (DD) are essential for diabetes management, quality of life, and reducing health care costs for people with diabetes. There was no standardized workflow for DD screening in an outpatient endocrine clinic that manages approximately 2000 persons with diabetes. Purpose: The purpose of this quality improvement (QI) project was to implement a screening and referral program for DD in an outpatient endocrine clinic. Methods: The QI project was implemented between August 31, 2020 – December 7, 2020. DD was measured using the Problem Areas in Diabetes-5 (PAID-5) scale (0 – 20) points. An ambulatory systems analyst created a flowsheet in Epic for the PAID-5 questionnaire and routed the PAID-5 to MyChart. Patients completed the PAID-5 on MyChart one week before the appointment or in-person during the encounter. Providers referred individuals with a PAID-5 score ≥ 8 to a mental health provider (MHP). Pre-and-post analysis of PAID-5 scores assessed for the reduction of PAID-5 scores and A1C values. Results: The PAID-5 screening compliance was 72% (n = 744/1028). It was identified that 31% (n = 228) had a PAID-5 score ≥ 8. Of those 228, only 24% received a referral to a MHP. Half the patients refused a referral, and 7% were already seeing a MHP. The average PAID-5 score was 5, and the baseline A1C value was 8% (< 5.7%). Conclusions: Screening for DD in adults with diabetes utilizing the PAID-5 questionnaire is feasible and can facilitate the referral of distressed patients to MHP’s. Long-term implications for the practice change include a holistic and comprehensive approach to the management of diabetes and diabetes-related outcomes, including reduction of A1C values in individuals referred to a MHP.