Diabetes management quality improvement - Diabetes - Brief Article

Nutrition Research Newsletter, Oct, 2001

Diabetes is a chronic disease that affects 15.7 million Americans, of whom only 10.3 million have this condition diagnosed. More than 70% of diabetic persons die of macrovascular disease associated with myocardial infarction and stroke. The Diabetes Control and Complications Trial has shown convincingly that improved glycemic control can substantially reduce the risk of microvascular complications in persons with type 1 diabetes. Major treatment goals in the diabetic patient are to optimize blood glucose control, reduce weight, and normalize lipid abnormalities and blood pressure. Ensuring that these diabetes care guidelines are incorporated into the daily practice of preliminary primary care providers requires substantial education and effort. The Northeast Iowa Family Practice Clinic (NEIFPC) has used several quality initiative measures to increase provider compliance with national diabetes care guidelines. The present study reports the cumulative success of these efforts in improving care of the NEIFPC diabetic population as compared with other Iowa physicians and with other published national data.

The present study was a retrospective cohort analysis using Medicare claims and chart abstraction data. Diabetic patients receiving care at the NEIFPC during 1996, 1997, and 1998 were included. Residents in the NEIFPC program have had point-of-care education through faculty staffing since the program started in 1979. Since 1992, samples of the resident physicians' medical charts have been formally audited by physician faculty to ensure provision and documentation of adequate care. A pharmacist faculty member has had resident physician education responsibilities since 1995. In 1998, the NEIFPC initiated a pharmacy residency program, and that resident also had considerable educational responsibilities. During 1993 the NEIFPC conducted a 3-month project of attaching Hb[A.sub.1]C reminder cards to the medical records of all diabetic patients who were being evaluated that day. The same year a diabetes care flow sheet was developed for clinic use. In 1996, the NEIFPC began requiring that nurses ask all diabetic patients to remove their shoes and stockings before the physician enters the examination room. Beginning in 1997, the NEIFPC facilitated a diabetes quality-improvement initiative with major local hospitals and clinic providers. The Iowa Foundation for Medical Care (IFMC) requested the opportunity to join that initiative, which led to the NEIFPC participation in the Diabetes Care Project.

Diabetic patients in NEIFPC were found to have greater utilization of diabetes care indicators than did patients of the Iowa State aggregate group in 1997 and 1998. NEIFPC patients had Hb[A.sub.1]C levels measured more frequently than did patients of Iowa collaborators. The percentage of NEIFPC patients with good glycemic control was 75%, compared with the reported 50% of all US patients. The findings of this study suggest that multimodal diabetes care quality improvement initiatives, applied longitudinally, can result in significant improvements in the provision and documentation of diabetes care.

J. Sutherland, J. Hoehns, B. O'Donnell, R. T Wiblin. Diabetes Management Quality Improvement in a Family Practice Residency Program. J Am Board Fam Pract 14(4):243-251 (2001) [Correspondence: John E. Sutherland, MD, Northeast Iowa Family Practice Residency Program, 2055 Kimball Ave., Waterloo, IA 50702].