Increasing recommended testing compliance for persons with type II diabetes in primary care

Abstract

Background: Type II diabetes affects one in 14 Montanans (Centers for Disease Control and Prevention (CDC), 2023). The CDC estimates annual direct and indirect costs of diabetes in Montana exceed $800 million (2023). Constraints persist when incorporating National Quality Forum measures and Healthy People 2030 objective guidance to address known challenges in managing Type II diabetes in a community setting due to minimal resources and lack of workflow appraisal. The rurality and radical weather patterns in Montana pose challenges for sustaining healthy diets and regular exercise. Purpose: The quality improvement project aims at generating consistent clinical decision support system (CDSS) electronic health record platform (EHR) reminders, streamlining workflow processes, and delaying Type II diabetes' concomitant conditions. Methods: A Plan-Do-Study-Act (PDSA) cycle employing Amazing Charts EHR to consistent clinical decision support system reminders, workflow process modification, and shared decision-making interventions. Purposive sampling included persons with Type II diabetes, 18-75 years, presenting for an annual visit type encounter. Interventions: Rule query preference entry and workflow process modification were monitored to a short-term goal benchmark of 90% for completion of recommended testing for persons with Type II diabetes. Data collection evaluated generation of CDSS reminders and annual completion of comprehensive foot examinations, urine microalbumin to creatinine ratio testing, and dilated eye examinations. Results: A total of six patients participated in the project, n = 5 met criteria for Type II diabetes diagnosis, n = 1 miscoded. The EHR generated CDSS reminders, and staff completed annual comprehensive foot examinations 83.33% of eligible encounters. Urine microalbumin testing was completed 66.63% of eligible encounters with n = 1 (16.33%) deferred testing until their annual visit. Strengths emerging from Strengths, Weakness, Opportunities, and Threats (SWOT) analysis included simple streamlined guidelines that promote teamwork. Conclusion: Consistent CDSS reminder facilitates recommendation completion, benefiting patients and providers. Although short term goals were not achieved at the 90% benchmark, the project is deemed clinically significant representing the homogeneity of Montanans. Future recommendations include participation in Merit-based Incentive Payment System (MIPS), extension of interventions for utilization of other chronic diseases, and integration of Current Procedural Terminology (CPT) codes for reimbursement for services.