This document outlines a quality improvement project to improve diabetes management in a primary care clinic. It notes that diabetic patients in the clinic are not meeting quality goals for HbA1c, LDL, and blood pressure. The project will test the effectiveness of providing quarterly reports on these measures and one-on-one care manager meetings (the intervention) versus usual care. The intervention aims to increase residents' awareness of clinical guidelines and engage patients. Project outcomes will assess the metrics over time and resident/care manager satisfaction to determine if the intervention is effective and worthwhile.

1. Quality Measures in
Diabetics
QIP Project
Shaun Cole, M.D., M.P.H
Patrick Smithedajkul, M.D.

2. Problem Statement
• Successful diabetes management can be
assessed using markers of target processes,
such as Hb A1c, LDL and blood pressure.
• Diabetic patients are not meeting quality goals
in the Baldwin PCIM clinic.

3. Root Cause Analysis

4. Magnitude
•Among US residents >65 years, 26.9% had DM in
2010
•Leading cause of kidney failure, NT lower-limb
amputations and new cases of adult blindness in the
US
•Major cause of heart disease and stroke
•7th leading cause of death in the US
•PCIM chart review - pending

5. Magnitude
• $174 billion:Total costs of diagnosed diabetes in
the United States in 2007
• $116 billion for direct medical costs
• $58 billion for indirect costs (disability, work loss,
premature mortality)

6. Magnitude
• Quality measures (LDL, blood pressure, Hgb A1C)
• What percentage of our diabetic patient’s have goal metrics in
all three?
• Answer: 20.3%
• What percentage of the consultant’s diabetic patients?
• Answer: 30.2%

7. Why Should We Care?
• For every 1% decrease in HbA1c, the chances of blindness,
amputations and renal disease decreases by 35% (Level A)
• Reduction of LDL below 100 and systolic BP les than 130
reduced CVD 40-50% (Level A)
• ADA clinical practice guidelines can be found at
www.diabetes.org

8. Stakeholders
• Consultants
• Residents
• Diabetic Care Managers
• Nursing staff
• Patients

9. Potential Interventions
• Resident Education to increase clinical guidelines
awareness
• Quarterly reports of patients’ metrics
• One-on-one time with diabetic care managers to
discuss critical gaps in management and patient
approach

10. Costs/Benefits
• Minimal costs
• Diabetic care managers already present
• Amalga Database present
• May take months to see benefit
• Potential risks- minimal
• Potential benefits- reduction in morbidity and
mortality, better relationships, save money in
healthcare, foster team-building in the workplace

11. Methods and Assessment
• Prospective cohort
• Between 4 firms, two will receive quarterly reports and
visits with care managers (intervention arm) and two will
receive “as needed” care manager time and reports
• Each quarter, quality metrics will be assessed
• Allows for both longitudinal progress of interventional arms
as well as direct comparative assessments to control arms

12. Methods and Assessment
• DM care manager time measurements
• compared between two cohorts
• Resident satisfaction
• assessed at the end of the intervention period using a 4-
point Likert scale
• DM Care manager satisfaction
• single focus group conducted at the end of 1 year

13. References
• Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates
and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA:
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
2011.
• Agency for Healthcare Research and Quality
www.ahrq.gov/browse/diabetes.htm
• American Association of Diabetes Educators
www.diabeteseducator.org
• American Diabetes Association
www.diabetes.org