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Improving comprehensive care for patients with diabetes

Patients with diabetes require access to systematic and ongoing care delivered by a team of healthcare providers. Despite national attention and well-accepted best practices, diabetic care, blood pressure and haemoglobin A1c (A1c) levels for patients with diabetes in our primary care setting were hi...

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Autores principales: Kutz, Tamar L, Roszhart, Jameson M, Hale, Marshall, Dolan, Virginia, Suchomski, Gerald, Jaeger, Cassie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202994/
https://www.ncbi.nlm.nih.gov/pubmed/30397656
http://dx.doi.org/10.1136/bmjoq-2017-000101
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author Kutz, Tamar L
Roszhart, Jameson M
Hale, Marshall
Dolan, Virginia
Suchomski, Gerald
Jaeger, Cassie
author_facet Kutz, Tamar L
Roszhart, Jameson M
Hale, Marshall
Dolan, Virginia
Suchomski, Gerald
Jaeger, Cassie
author_sort Kutz, Tamar L
collection PubMed
description Patients with diabetes require access to systematic and ongoing care delivered by a team of healthcare providers. Despite national attention and well-accepted best practices, diabetic care, blood pressure and haemoglobin A1c (A1c) levels for patients with diabetes in our primary care setting were highly variable and below the Healthcare Effectiveness Data and Information Set (HEDIS) 75th percentile benchmark. From January 2015 to January 2016, 22% of patients with diabetes in our primary care setting had both blood pressure and A1c levels controlled and 23% had their annual diabetic care bundle completed, which includes A1c and blood pressure measurements, foot examination and nephropathy attention. Lack of standardised care algorithms, electronic health record documentation and education was identified. Lean Six Sigma methodologies were used to re-engineer the care that patients with diabetes receive. Key improvement initiatives focused on standardisation of accepted care practices through electronic templates, education and re-evaluation of patients to make 90-day, rapid cycle changes. Interventions were piloted in one primary care clinic then expanded to eight additional clinics. At the pilot site, the per cent of patients who completed the diabetic care bundle increased from 33% to 71% and the per cent of patients with diabetes with both A1c and blood pressure controlled increased from 31% to 43% (two-proportion test, p<0.01) postintervention. On rollout to eight additional clinics, the per cent of patients who completed the diabetic care bundle increased from 23% to 67% and the per cent of patients with diabetes with both their A1c and their blood pressure controlled increased from 22% to 41% (two-proportion test, p<0.01). After the interventions, nephropathy attention, A1c and blood pressure metrics exceeded HEDIS 75th percentile. Standardisation of accepted care practices for patients with diabetes improved compliance with diabetic care bundle completion and patient outcomes in the primary care setting.
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spelling pubmed-62029942018-11-05 Improving comprehensive care for patients with diabetes Kutz, Tamar L Roszhart, Jameson M Hale, Marshall Dolan, Virginia Suchomski, Gerald Jaeger, Cassie BMJ Open Qual BMJ Quality Improvement report Patients with diabetes require access to systematic and ongoing care delivered by a team of healthcare providers. Despite national attention and well-accepted best practices, diabetic care, blood pressure and haemoglobin A1c (A1c) levels for patients with diabetes in our primary care setting were highly variable and below the Healthcare Effectiveness Data and Information Set (HEDIS) 75th percentile benchmark. From January 2015 to January 2016, 22% of patients with diabetes in our primary care setting had both blood pressure and A1c levels controlled and 23% had their annual diabetic care bundle completed, which includes A1c and blood pressure measurements, foot examination and nephropathy attention. Lack of standardised care algorithms, electronic health record documentation and education was identified. Lean Six Sigma methodologies were used to re-engineer the care that patients with diabetes receive. Key improvement initiatives focused on standardisation of accepted care practices through electronic templates, education and re-evaluation of patients to make 90-day, rapid cycle changes. Interventions were piloted in one primary care clinic then expanded to eight additional clinics. At the pilot site, the per cent of patients who completed the diabetic care bundle increased from 33% to 71% and the per cent of patients with diabetes with both A1c and blood pressure controlled increased from 31% to 43% (two-proportion test, p<0.01) postintervention. On rollout to eight additional clinics, the per cent of patients who completed the diabetic care bundle increased from 23% to 67% and the per cent of patients with diabetes with both their A1c and their blood pressure controlled increased from 22% to 41% (two-proportion test, p<0.01). After the interventions, nephropathy attention, A1c and blood pressure metrics exceeded HEDIS 75th percentile. Standardisation of accepted care practices for patients with diabetes improved compliance with diabetic care bundle completion and patient outcomes in the primary care setting. BMJ Publishing Group 2018-10-15 /pmc/articles/PMC6202994/ /pubmed/30397656 http://dx.doi.org/10.1136/bmjoq-2017-000101 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle BMJ Quality Improvement report
Kutz, Tamar L
Roszhart, Jameson M
Hale, Marshall
Dolan, Virginia
Suchomski, Gerald
Jaeger, Cassie
Improving comprehensive care for patients with diabetes
title Improving comprehensive care for patients with diabetes
title_full Improving comprehensive care for patients with diabetes
title_fullStr Improving comprehensive care for patients with diabetes
title_full_unstemmed Improving comprehensive care for patients with diabetes
title_short Improving comprehensive care for patients with diabetes
title_sort improving comprehensive care for patients with diabetes
topic BMJ Quality Improvement report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202994/
https://www.ncbi.nlm.nih.gov/pubmed/30397656
http://dx.doi.org/10.1136/bmjoq-2017-000101
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