Within the United States the number of patients affected by diabetes is rapidly increasing. With that increase, a growing cost in dollars and lost productivity is also expected. Poorly managed diabetes as a result of an ineffective health care system or lack of patient involvement leads to increased complications of the disease and ultimately a poor outcome. Accordingly, it is essential for health care providers to improve patient engagement in disease management and quality of care and outcomes. In the San Joaquin Valley of Central California, prevalence of diabetes continues to escalate and the latest statistics provided by the California Department of Public Health estimates one in ten persons in the San Joaquin Valley has diabetes. Applying strategies demonstrating even small improvements in A1c testing and resulting in obtaining optimal values can help to combat morbidity and mortality in the San Joaquin Valley of California. The Agency for Healthcare Research and Quality (AHRQ) suggested diabetes care has continued to fall short of recommended standards of care. A high priority should be given to using evidence-based practice (EBP) in any such strategy. The AHRQ suggests the implementation of at least two quality improvement strategies can have some impact on patient compliance with disease management. To meet this challenge, a practice change utilizing two strategies to improve patient engagement in their disease management was proposed and implemented. The practice change in diabetes care included: (a) telephone reminders for glycosylated hemoglobin testing; (b) disease management monitoring by the nurse practitioner. The Ottawa Decision Support Framework was used for this project. This framework presents a systems approach to evaluate patient needs and health beliefs while working toward the implementation of interventions to improve wellbeing. This framework offers guidance in the evaluation of values and beliefs. For this project utilizing interactive and focused approaches to improve diabetes management and the evaluation of the effect of those interventions on diabetes processes were seen as a worthwhile endeavor. A transformational system change that provided patients with diabetes phone reminders for A1c testing was implemented within a family practice clinic. The electronic record was queried for evidence of A1c testing and results. The project nurse practitioner served as the care manager and oversight of patients with diabetes. The practice change implemented provided a more focused approach to diabetes with the added benefit of more timely feedback. There were 311 patients included in the project intervention. Conclusions indicated an improved testing compliance but failed to show improvemet in A1c value. However, this may be an indication of initial increased testing frequency of patients with poor glycemic control. Initial increases in A1c percentages should be expected in the short term as a result of capturing those patients who were poorly controlled and those failing to test at regular intervals prior to the intervention. Implementation of these two practice change strategies are a cost effective approach to diabetes care leading to improvement in outcomes for patients with diabetes. Improvement in the outcomes can lead to an overall cost decrease to the health care system as a whole. More work is needed to improve A1c control in patients having difficulty achieving glycemic control. Strategies that may assist this desired goal should be readilty embraced and implemented in all health care settings.
