School of Medicine and Health Sciences Poster Presentations

Title

Sweet! Resident-driven QI Leads to 50% Improvement in DM2 Screening

Poster Number

300

Document Type

Poster

Publication Date

3-2016

Abstract

Background:

Type 2 diabetes mellitus, a chronic degenerative metabolic disease, affects more than 400 million people worldwide. Early treatment has been shown to avoid morbidity and mortality (1). Recent evidence suggests that systematic screening benefits a larger population than previously thought and prevents the development of Type 2 diabetes and associated morbidity (2).

Aim Statement:

To increase the appropriate screening rate for Type 2 diabetes mellitus by fifty percent over a seven month period (as defined by the 2015 guidelines by the U.S. Preventative Services Task Force).

Methods:

a. Measures:

The percentage of patient visits in resident clinic, in which screening at the interval recommended by current USPSTF recommendations had been performed (every three years in individuals at increased risk). Individuals at increased risk include those aged 40 to 70 with a BMI of 25 or greater, women with a history of gestational diabetes or PCOS, and individuals with a family history of diabetes or those of certain ethnic groups.

b. Interventions:

The authors performed resident education both through electronic reminders alone (Intervention I) as well as combined with lectures about the new practice guidelines and the efficacy of systematic screening to reduce the burden of diabetes related disease (Intervention II). Senior attendings who are supervising residents were informed about and invited to discuss the new guidelines with residents as part of their preceptor role (Intervention III).

Results:

The baseline rate of adequate screening was 60.00 percent of the eligible patient encounters (96/160). Following Intervention I, the rate remained virtually unchanged at 60.81%. Following Intervention II, the screening rate increased to 72.55 percent (111/151). This improvement was maintained the following month (130/183; 71.04%). Following Intervention III, screening rate improved to 96.00 percent (24/25; preliminary data).

In the primary-care setting, the interventions increased the percentage of adequately diabetes-screened patients from 60% to 96%. The initial interventions, which were targeted at residents alone, were followed by a slight increase in screening rates, more so when combined than in isolation. The third intervention, which included senior physicians showed the greatest improvement.

Discussion/Next steps:

Our observations are consistent with research regarding quality improvement in hand hygiene which suggests that bundles of measures are more effective, and that multimodal approaches e.g. those including leadership personnel, are more effective than interventions that provide education alone (3). We are hopeful that the improvements will lead to decreases in morbidity and mortality in our patient population. Going forward, the authors plan to construct an annual physical template to serve as a memory aid to alert physicians when diabetes screening is indicated or if funding can be obtained create a software based support system to standardize screening practices and continue to improve quality of care and the health of our patients.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at: GW Research Days 2016

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Sweet! Resident-driven QI Leads to 50% Improvement in DM2 Screening

Background:

Type 2 diabetes mellitus, a chronic degenerative metabolic disease, affects more than 400 million people worldwide. Early treatment has been shown to avoid morbidity and mortality (1). Recent evidence suggests that systematic screening benefits a larger population than previously thought and prevents the development of Type 2 diabetes and associated morbidity (2).

Aim Statement:

To increase the appropriate screening rate for Type 2 diabetes mellitus by fifty percent over a seven month period (as defined by the 2015 guidelines by the U.S. Preventative Services Task Force).

Methods:

a. Measures:

The percentage of patient visits in resident clinic, in which screening at the interval recommended by current USPSTF recommendations had been performed (every three years in individuals at increased risk). Individuals at increased risk include those aged 40 to 70 with a BMI of 25 or greater, women with a history of gestational diabetes or PCOS, and individuals with a family history of diabetes or those of certain ethnic groups.

b. Interventions:

The authors performed resident education both through electronic reminders alone (Intervention I) as well as combined with lectures about the new practice guidelines and the efficacy of systematic screening to reduce the burden of diabetes related disease (Intervention II). Senior attendings who are supervising residents were informed about and invited to discuss the new guidelines with residents as part of their preceptor role (Intervention III).

Results:

The baseline rate of adequate screening was 60.00 percent of the eligible patient encounters (96/160). Following Intervention I, the rate remained virtually unchanged at 60.81%. Following Intervention II, the screening rate increased to 72.55 percent (111/151). This improvement was maintained the following month (130/183; 71.04%). Following Intervention III, screening rate improved to 96.00 percent (24/25; preliminary data).

In the primary-care setting, the interventions increased the percentage of adequately diabetes-screened patients from 60% to 96%. The initial interventions, which were targeted at residents alone, were followed by a slight increase in screening rates, more so when combined than in isolation. The third intervention, which included senior physicians showed the greatest improvement.

Discussion/Next steps:

Our observations are consistent with research regarding quality improvement in hand hygiene which suggests that bundles of measures are more effective, and that multimodal approaches e.g. those including leadership personnel, are more effective than interventions that provide education alone (3). We are hopeful that the improvements will lead to decreases in morbidity and mortality in our patient population. Going forward, the authors plan to construct an annual physical template to serve as a memory aid to alert physicians when diabetes screening is indicated or if funding can be obtained create a software based support system to standardize screening practices and continue to improve quality of care and the health of our patients.