Quality Improvement in Diabetes Management
Introduction
In a 2001 publication, titled “Across the Chasm: Six Aims for Changing Healthcare,” the Institute of Medicine (IOM) reveals disparities in healthcare delivery in the United States healthcare system, and illuminated the gap between high quality healthcare and the actual care American’s receive. Additionally, the IOM suggested six indicators for improving healthcare, which are the six aims of quality improvement in healthcare delivery: Safe, Effective, Patient-centered, Timely, Efficient, and Equitable (IOM, 2001). Quality improvement is the process of examining current standards and practices, methodically evaluating current evidenced-based best practices, implementing new evidenced best practices, and continually re-evaluating to preserve improved outcomes. The objective is quality improvement by meticulously monitoring outcomes of recently adopted interventions (Pinkerton, 2008). Quality Improvement Objective The purpose of this paper is to evaluate current diabetic management protocols in the internal medicine clinic to improve healthcare delivery aimed at decreasing diabetic complications, and improving healthcare quality by evaluating charts of clinic’s diabetic patients to assess if benchmarks of quality metrics in diabetic care were met. Methods A chart review was conducted, and five charts were examined to quantify the quality of diabetic care provided by evaluating if four process measures, promulgated by the National Quality Measures Clearinghouse (NQMC) of clinical quality metrics in diabetic management outcomes were met, which were: 1. …show more content…
Continuous glucose monitoring using glycated hemoglobin (HbA1C), 2. Statin therapy, 3. Annual urine albumin screening, 4. Annual eye exam (NQMC, 2015). These four clinical quality measures are among nine process measures recognized by (NQMC), and currently used as evaluation criteria to assess the quality of care provided to the diabetic population by primary care providers. Inclusion criteria for charts selected for this review included current visits within the previous six months, and a diabetes mellitus type 2 diagnoses greater than 5 years. Exclusion criteria included diabetic complications such as: chronic kidney disease comorbidity; end-stage renal disease; amputations; diabetic neuropathies; coronary artery disease, comorbidities such as: anemia and congestive heart failure, and corticosteroid therapy. Of the five charts selected, all were regularly filling anti-diabetic medications, four of the five charts had a documented diabetic nutritional consultation, and three of the five had regular physical activity documented. One had current smoker documented, and none were on psychotropic medications. QI Summary and Analysis Based on review findings, the internal medicine clinic is meeting three of the four process measures evidenced by documented results of three out of four diabetic clinical quality measures in one hundred percent of the charts reviewed, which include: HbA1c; statin therapy; and annual urine albumin screening. …show more content…
The fourth process measure – annual eye exam, only had documented results for an annual eye exam in forty percent of the charts reviewed. By extrapolating the data in this review, it can be concluded that the internal medicine clinic providers are delivering suboptimal care to their diabetic patient population by not following current diabetic management guidelines, and failing to fully meet clinical quality measures supported by the NQMC. Recommendations Recommendations of this quality improvement review are to increase annual eye examinations in the diabetic population with a target aim of one hundred percent compliance. According to the American Diabetes Association (ADA), work-up of
Introduction
In a 2001 publication, titled “Across the Chasm: Six Aims for Changing Healthcare,” the Institute of Medicine (IOM) reveals disparities in healthcare delivery in the United States healthcare system, and illuminated the gap between high quality healthcare and the actual care American’s receive. Additionally, the IOM suggested six indicators for improving healthcare, which are the six aims of quality improvement in healthcare delivery: Safe, Effective, Patient-centered, Timely, Efficient, and Equitable (IOM, 2001). Quality improvement is the process of examining current standards and practices, methodically evaluating current evidenced-based best practices, implementing new evidenced best practices, and continually re-evaluating to preserve improved outcomes. The objective is quality improvement by meticulously monitoring outcomes of recently adopted interventions (Pinkerton, 2008). Quality Improvement Objective The purpose of this paper is to evaluate current diabetic management protocols in the internal medicine clinic to improve healthcare delivery aimed at decreasing diabetic complications, and improving healthcare quality by evaluating charts of clinic’s diabetic patients to assess if benchmarks of quality metrics in diabetic care were met. Methods A chart review was conducted, and five charts were examined to quantify the quality of diabetic care provided by evaluating if four process measures, promulgated by the National Quality Measures Clearinghouse (NQMC) of clinical quality metrics in diabetic management outcomes were met, which were: 1. …show more content…
Continuous glucose monitoring using glycated hemoglobin (HbA1C), 2. Statin therapy, 3. Annual urine albumin screening, 4. Annual eye exam (NQMC, 2015). These four clinical quality measures are among nine process measures recognized by (NQMC), and currently used as evaluation criteria to assess the quality of care provided to the diabetic population by primary care providers. Inclusion criteria for charts selected for this review included current visits within the previous six months, and a diabetes mellitus type 2 diagnoses greater than 5 years. Exclusion criteria included diabetic complications such as: chronic kidney disease comorbidity; end-stage renal disease; amputations; diabetic neuropathies; coronary artery disease, comorbidities such as: anemia and congestive heart failure, and corticosteroid therapy. Of the five charts selected, all were regularly filling anti-diabetic medications, four of the five charts had a documented diabetic nutritional consultation, and three of the five had regular physical activity documented. One had current smoker documented, and none were on psychotropic medications. QI Summary and Analysis Based on review findings, the internal medicine clinic is meeting three of the four process measures evidenced by documented results of three out of four diabetic clinical quality measures in one hundred percent of the charts reviewed, which include: HbA1c; statin therapy; and annual urine albumin screening. …show more content…
The fourth process measure – annual eye exam, only had documented results for an annual eye exam in forty percent of the charts reviewed. By extrapolating the data in this review, it can be concluded that the internal medicine clinic providers are delivering suboptimal care to their diabetic patient population by not following current diabetic management guidelines, and failing to fully meet clinical quality measures supported by the NQMC. Recommendations Recommendations of this quality improvement review are to increase annual eye examinations in the diabetic population with a target aim of one hundred percent compliance. According to the American Diabetes Association (ADA), work-up of