Diabetes has become a national epidemic affecting about 29.1% of Americans, approximately 9.3% of the population (Shirivastav et al., 2018). Yet, an estimated 20 % remain undiagnosed, while the annual new case estimate is about 1.4 million (Shirivastav et al., 2018). In 2013, among patients seeking medical primary care visits, diabetes was the fifth-ranked primary diagnosis according to the centers for disease control and prevention center (2021). Hence, one can argue how essential primary care is to effectively screen, diagnose, and manage patients with type Two diabetes, realizing the implications of poor control, leading to disease progression to chronic complications such as microvascular and macrovascular diseases or possible life-threatening hypoglycemia.
According to the standards of diabetes care, controlling glucose improves Glyco hemoglobin (HbA1c) levels over time. Other factors associated with delaying complications are maintaining target blood pressure and lowering low-density cholesterol levels, which prevents chronic complications of diabetes. Therefore, primary care centers must make a concerted effort to adopt the national standards of care by developing a quality improvement program by identifying gaps to prevent poor patient outcomes leading to poor compliance. Examples of such gaps include poor glucose control goals in patients with type 2 diabetes as evidence by HbA1c not at
goal rate, patients with diabetes not achieving target blood pressure goal of 130/80 and low-density lipoprotein cholesterol levels above the target rate (Kitson, & Straus, 2010).
The quality improvement gap I would like to address at my current clinic is improving HbA1c to goal range among patients above the target range. This facility has a quality improvement team comprising a nurse manager, behavioral health, nurses, Nurse practitioners, and medical assistants. Evidence-based standards of practice emphasize patients with HBA1c greater than 7% repeat testing within six weeks. Using the PDSA method by predicting a clear outcome of HbA1c of <7% (Taylor & Bircher, 2016).
Plan: Decide on one team member to send out appointment reminders to patients with HbA1c above target, would measure the time between the out-of-target HbA1c received, review appointment, and when they would introduce the change (Taylor & Bircher, 2016).
Next is the Do section here, when the team monitors if there is an increased workload for the nursing because of increased appointments and patient compliance. The study phase is after three to six months, data is collected and analyzed, and finally, the Act phase is where the team acts on the positive change determines (IHI. 2021). Additionally, in this action phase, the team can publish the PDSA findings for implementation in the clinic or adjust for further improvement. The second tool applicable to improving glycemic control is the lean six sigma which focuses on defects. I will use this method to develop a nursing workflow in facilitating intervention to improve glycemic control (Kollipara et al., 2021). Finally, utilizing these two quality measures will improve the identified gaps and enhance euglycemia among patients with type 2 diabetes at the community-based clinic.
References:
Centers for Disease Control and Prevention. (2021). Ambulatory care use and physician office visits. https://www.cdc.gov/nchs/fastats/physician-visits.htm.
Institute for Healthcare Improvement (IHI), (2021). http://www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials-Toolkit.aspx
Kollipara, U, Rivera-Bernuy, M., Putra, J., Burks, J., Meyer, A., Ferguson, S., Nelson, C., Mutz, J., Mirfakhraee, S., Bajaj, P., Kermani, A, Fish, J. S., and Ali, S. (2021). Improving diabetes control using lean six sigma quality improvement in an endocrine clinic in a large accountable care organization. Clinical Diabetes. 39(1): 57-63.
Shrivastav, M., Gibson, W Jr., Shrivastav, R., Elzea, K., Khambatta, C., Sierra, J. A., and Vigersky, R. (2018). Type 2 diabetes management in primary care: The role of retrospective professional continuous glucose monitoring. Diabetes Spectrum 31(3):
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