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As per American Diabetes Association, diabetes is a 'complex chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control'. In 2018, the prevalence of diabetes mellitus in the US population was 10.5% (34.2 million people). It is the seventh leading cause of death in the United States. The average healthcare expenditure is 2.3 times higher for diabetics than non-diabetics. The goal of diabetes care as per the American Diabetes Association and the American College of Cardiology is HbA1c less than 7%, blood pressure less than 140/90mmHg, and LDL cholesterol less than 100mg/dl. Only 19.2% of diabetic population meet all these criteria. At the Guthrie-Robert Packer Hospital, we use the 'Diabetic Bundle' as a quality metric for the standard of care for diabetic patients. It is a metric with diabetic patients seen in the past 2 years who have an active Guthrie PCP, with A1C less than 8 in the past 6 months, LDL less than 70 mg/dl (or currently prescribed a moderate or high dose statin) in the past year and age 40-75, and medical attention for nephropathy (a microalbumin test in the past year, or a nephrology visit, or are on an ACE/ARB, or have ESRD/CKD Stage 4) as a system numerator and total diabetes patients seen in the last 2 years who have an active Guthrie PCP as a system denominator. For the past few years, the resident's clinic has had lower compliance with the diabetic bundle. Multiple factors were responsible. Lack of awareness about the quality metric, discontinuity of care, failure to educate patients, poor patient involvement in diabetes care, socio-economic barriers like lack of insurance, poor family and social support, lack of transportation, poor patient compliance, and low health literacy were some of the identified factors. We conducted the prospective study to improve diabetes care by assessing 'diabetic bundle' compliance. Key interventions were focused on creating a multidisciplinary care team of the clinic director, care coordinator, informatics, nurse, resident, and faculty. Resident education regarding the diabetic bundle, patient education and involvement in diabetes care, outreach calls and mails to the non-compliant, involving the care coordinator in addressing social needs, and regular updating of the diabetes registry were some of the main interventions done during the study period. All these interventions contributed to improvement in the diabetic bundle but we believe that the most important factor in improving diabetes care was educating the patients, involving them in their diabetes care, and addressing their social determinants of health. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m. |
