School of Medicine and Health Sciences Poster Presentations

Evaluating Impact of Resident Feedback on Diabetic Patient Outcomes

Poster Number

299

Document Type

Poster

Publication Date

3-2016

Abstract

Introduction: Residents are often unaware of their performance in clinic as compared to that of their peers. The intent of this project was to improve resident compliance with best care practices for diabetic patients using a novel feedback system to gauge performance in clinic. Per American Diabetes Association guidelines, diabetics should be screened annually for kidney disease with a urine microalbumin/creatinine ratio. Routine screening is integral in preventing and/or treating diabetic nephropathy, which is the leading cause of kidney failure in the United States. Diabetics with proteinuria benefit from close medical follow up to ensure tight blood pressure and glucose control.

Methods: The study was conducted at an urban academic ambulatory center. The study population consisted of members of a categorical internal medicine residency program, with a 4+1 ambulatory model. Our sample was comprised of 19 residents with an even distribution among PGY-1, PGY-2, and PGY-3. A total of 249 patients were evaluated.

First, we reviewed the charts of patients seen in clinic by our 19 residents over the previous two ambulatory weeks. Patients with “diabetes mellitus” listed as a medical problem by ICD code were identified. Then, we surveyed these patient’s records for a urine microalbumin/creatinine checked within the past year.

Subsequently, the residents were presented with individual and group compliance rates, and the recommendations for screening were reviewed through a short teaching module. The data was communicated via PowerPoint presentation at a weekly didactics session. Residents were notified that their performance would be reviewed again after another two ambulatory weeks. We hypothesized that there would be a significant increase in compliance with screening after administration of the feedback and education intervention.

Results: Pre-intervention data analysis showed that 63% of the 99 diabetic patients seen in clinic over the course of two ambulatory weeks had a screening urine microalbumin/creatinine within the last year. During the two ambulatory weeks post-intervention, there was a 74% screening rate for 150 diabetic patients seen. Nine of 19 residents had screening rates of greater than 80%. The P-value was 0.06 for pre- and post-intervention comparison.

Conclusions: While subjective feedback for residents from attending physicians is well-documented and frequently provided, objective feedback via chart audit is a less common component of residency programs. Though our initial data was not significant, it suggests a positive clinician behavioral shift in response to receiving data about patient management performance. A major limitation of this study is the small sample size. A potential confounding bias is that post-intervention data was collected later in the year, when residents were likely more experienced. In the future, we plan to expand this intervention to a larger sample of residents. We also anticipate monitoring appropriate initiation of ace inhibitors for patients with microalbuminuria.

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Presented at: GW Research Days 2016

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Evaluating Impact of Resident Feedback on Diabetic Patient Outcomes

Introduction: Residents are often unaware of their performance in clinic as compared to that of their peers. The intent of this project was to improve resident compliance with best care practices for diabetic patients using a novel feedback system to gauge performance in clinic. Per American Diabetes Association guidelines, diabetics should be screened annually for kidney disease with a urine microalbumin/creatinine ratio. Routine screening is integral in preventing and/or treating diabetic nephropathy, which is the leading cause of kidney failure in the United States. Diabetics with proteinuria benefit from close medical follow up to ensure tight blood pressure and glucose control.

Methods: The study was conducted at an urban academic ambulatory center. The study population consisted of members of a categorical internal medicine residency program, with a 4+1 ambulatory model. Our sample was comprised of 19 residents with an even distribution among PGY-1, PGY-2, and PGY-3. A total of 249 patients were evaluated.

First, we reviewed the charts of patients seen in clinic by our 19 residents over the previous two ambulatory weeks. Patients with “diabetes mellitus” listed as a medical problem by ICD code were identified. Then, we surveyed these patient’s records for a urine microalbumin/creatinine checked within the past year.

Subsequently, the residents were presented with individual and group compliance rates, and the recommendations for screening were reviewed through a short teaching module. The data was communicated via PowerPoint presentation at a weekly didactics session. Residents were notified that their performance would be reviewed again after another two ambulatory weeks. We hypothesized that there would be a significant increase in compliance with screening after administration of the feedback and education intervention.

Results: Pre-intervention data analysis showed that 63% of the 99 diabetic patients seen in clinic over the course of two ambulatory weeks had a screening urine microalbumin/creatinine within the last year. During the two ambulatory weeks post-intervention, there was a 74% screening rate for 150 diabetic patients seen. Nine of 19 residents had screening rates of greater than 80%. The P-value was 0.06 for pre- and post-intervention comparison.

Conclusions: While subjective feedback for residents from attending physicians is well-documented and frequently provided, objective feedback via chart audit is a less common component of residency programs. Though our initial data was not significant, it suggests a positive clinician behavioral shift in response to receiving data about patient management performance. A major limitation of this study is the small sample size. A potential confounding bias is that post-intervention data was collected later in the year, when residents were likely more experienced. In the future, we plan to expand this intervention to a larger sample of residents. We also anticipate monitoring appropriate initiation of ace inhibitors for patients with microalbuminuria.