Increasing Referral Rates to the Diabetic Educator at Time of Diabetes Diagnosis

Abstract

Problem: The American Diabetes Association (ADA) recommends that formal education is provided by a certified diabetic educator to all adults newly diagnosed with type 2 diabetes. A local primary care clinic in Maryland has a diabetic educator available to patients. Despite this resource and ADA recommendations, this clinic has a low number of referrals to the diabetic educator compared to their sister location. From October 11, 2021, to February 22, 2023, the clinic had 116 referrals to the educator, compared to 274 referrals entered at the sister location. Purpose: The purpose of this quality improvement (QI) initiative is to use an implementation bundle, including a written policy and a referral order panel to support the ADA guidelines at the clinic. Education, reminders, as well as audit and feedback were included in the bundle. Methods: The new policy was written by the project lead based on the ADA guidelines and then approved by the clinic’s manager. Once the policy was in effect, education on the ADA guidelines and the policy were provided to the staff members. A referral order panel was added to the providers’ preference list. The order panel included referral orders to the diabetic educator, ophthalmology, and podiatry. Biweekly feedback was provided to the staff after one month of initiation to ensure provider adherence to the project. Results: Weekly chart audits were conducted by the project lead. A month prior to project implementation, only 40% of newly diagnosed patients were referred to the educator. After one month of the initiative, the referral rate increased from 0% in the first week to 83% in the last week. By the end of the project, 100% of newly diagnosed patients were referred to the educator. Conclusions: A combined intervention using a protocol, order panel, and audit with feedback increased referral rates to the diabetic educator at the local clinic. Using a multi-faceted approach was successful at modifying provider behavior and implementing guidelines into practice.