SAT113 Reducing The Frequency Of Ordering Hemoglobin A1c In Patients With Well-controlled Diabetes - A Quality Improvement Project

Disclosure: G. Umarji: None. K. Swedish: None. V. Tabatabaie: None. Introduction: “Let’s check an A1c” is a sentence heard often in primary care setting. Is it truly required each time? According to Standards of Care 2021 by American Diabetes Association, hemoglobin A1c should be tested every six months for patients with well-controlled diabetes. The cost of hemoglobin a1c test ranges $28 to $245, with an average of $85.20 without insurance. Unnecessary blood tests cause discomfort and anxiety to patients and increase healthcare costs. We conducted a quality improvement project whose aim was to decrease the frequency of unnecessary hemoglobin A1c testing by 50% from March 2022 to March 2023 at an internal medicine residency clinic. Methods: Our discovery phase included a survey of all providers in the residency clinic and a chart review. The goal of the survey was to understand how clinicians identified well-controlled diabetes. The survey was sent to 86 providers (attendings and residents) with a response rate of 43%. Results showed a shortcoming to define goal A1c for adults >65 years of age. Less than half knew that a patient with well-controlled diabetes should have A1c checked every 6 months. A chart review was conducted for all patients seen by attendings and residents as primary care providers in clinic with hemoglobin A1c between 6.5 and 8.5. Of the 462 total patients, a representative sample revealed that 38% of the patients with well-controlled diabetes (defined with goal A1c from standards of care 2021) had A1c ordered sooner than recommended. Three interventions have been planned to reduce this occurrence. The first intervention was an educational session with attendings, as they act as point regulators for every plan made for clinic patients. Results: Eight weeks after the first intervention, a similar chart review was conducted, which demonstrated a decrease in patients with well-controlled diabetes having A1c sent sooner than recommended from 38% to 33%. Discussion: The second intervention, an educational session with the residents, was performed and data is being gathered to determine the efficacy of that intervention. The third planned intervention will be to post information about A1c ordering in the precepting room at the clinic. We know that training is the least effective method to obtain change, an ideal intervention would be to introduce a hard stop in the electronic medical record (EMR) asking if the physician truly wanted to order another A1c since the last was ordered x months ago with the result of y%. However, despite being a more effective method of change, it is very expensive and difficult to introduce new measures into our EMR. Following our third intervention, we will reassess to determine if further interventions would benefit our goal of decreasing unnecessary A1c testing in patient with well-controlled diabetes. Presentation: Saturday, June 17, 2023