Improving Provider Adherence to Diabetes Standard of Care with Clinical Practice Aids

Abstract

Problem: Nearly one third of patients with Type 2 Diabetes at a primary care practice outside Washington D.C. were unable to achieve glycemic control (hemoglobin A1c < 6.5%). A retrospective chart review from Fall 2022 revealed that 0% of these patients received all of the recommended screenings per the American Diabetes Association’s 2023 clinical practice guidelines for diabetic neuropathy (foot exam), retinopathy (eye exam), nephropathy (serum uACR & eGFR), and a current hemoglobin A1c. Purpose: The purpose of this quality improvement project was to improve provider adherence to the latest diabetes clinical practice guidelines with practice aids implemented at the time of provider visit. Methods: Prior to implementation, diabetic screening flowsheets were clipped to patient charts and visual reminders were posted in every room. In the Fall of 2023, data was collected weekly on provider adherence to screening guidelines via chart audits of serum blood values and preventative exams. Any lapsed screenings were ordered or referred to a specialist in the same encounter. Results: Results over 15 weeks yielded 93 eligible patient (hemoglobin A1c > 6.5%) encounters. 89 (95.7%) were current after project implementation with their last hemoglobin A1c measured within three months (pre-intervention 69.7%). 80 (86.0%) were current with an annual renal profile (pre-intervention 3.0%). 67 (72.0%) were current with an annual eye exam (preintervention 3.0%). 57 (61.3%) were current with an annual foot exam (pre-intervention 6.0%). 55 (59.1%) were current with all four screenings (pre-intervention 0.0%). Conclusion: Findings suggest practice aids implemented at the point-of-care can improve provider adherence to diabetes clinical practice guidelines which could reduce future incidences of diabetic complications.