The purpose of this project was to determine if providers at a Family Practice are providing diabetes care based on standards of care as outlined by the American Diabetes Association. More than 25 million people in the United States were diagnosed with diabetes within the past year associated with a death rate of 7% annually. Additionally, diabetes can lead to comorbid conditions such as hypertension, hyperlipidemia, cardiovascular disease, retinopathy, and neuropathy, all of which lead to an increase in mortality and morbidity as well as increased medical cost. Administrators at the practice perform regular random chart evaluations to determine if care is being provided based on ICD9 codes for various chronic diseases. During a recent review, the review indicated that 47% providers did not meet the standards of care for diabetes patients. The impact could lead to comorbid conditions with increasing risks of heart attacks, stroke, amputation, blindness, and renal diease annually. Necessary objectives to achieve these outcomes are improvement in providing care that aligns with the standards of care for diabetics which includes timely measurement of hemoglobin AIC values, fasting lipid panels, liver function tests, renal test, annual dilated eye examinations, periodic diabetic foot examinations, dental care, and if necessary, mental health evaluations. In order to accomplish this practice change, Rosswurm and Larrabee’s six step model for implementing evidence-based practice was utilized. Implement this change. The theoretical framework chosen is the Service Quality Model, also known as customer service framework. From the preliminary findings of the chart review, 47% of time providers did not follow the standards of care for diabetic patients. This particular problem has been demonstrated nationally throughout the literature. One exmaple is a study conducted by White, Beech, & Miller, showing that “significant disparities in both the processes of care and health outcomes relevant to diabetes management persist across the country”. Additionally, O’Conner et al., and Kirkman, Williams, Caffery & Marrero, state that the “gap between recommended diabetes care and care actually received by patients is substantial” and “chart audits and reviews of administrative databases have shown that the quality of diabetes care is suboptimal”. Once our project began our care for diabetic patients greatly improved from 47% of the time to 75% of the time diabetic care was provided by this clinic. In conclusion, the care for diabetic patients has been shown to be suboptimal throughout the United States. This project has demonstrated that staff and provider education along with ongoing dialogue can improve diabetes care.
