Improving the utilization of Diabetes Self-Management Education and Support (DSMES) for patients with type II diabetes in the primary care setting

Abstract

Evidence suggests that diabetes self-management education and support (DSMES) programs result in numerous clinical, psychosocial, behavioral, and cost benefits. The American Diabetes Association (ADA) recommends that all patients with a diagnosis of type II diabetes (T2DM) should participate in ongoing DSMES. The ADA provides an algorithm that highlights four critical criteria for referral to DSMES, but substantial evidence suggests that these referral guidelines are not widely followed. The purpose of this project was to implement a standardized referral process in a central Montana primary care clinic using the ADA Algorithm of Care. Participating providers were educated about the ADA referral guidelines and asked to follow them diligently. The referral algorithm was uploaded to the clinic share drive and displayed on the wall of each exam room to encourage its use. Both pre- and post-implementation data were collected via electronic health record (EHR) chart review. The number of referrals sent was compared to the number of patients who met criteria for referral and displayed as a percentage using individual run charts for three separate categories: (1) new diagnosis of T2DM, (2) existing diagnosis of T2DM and no previous DSMES participation, and (3) existing diagnosis of T2DM with previous DSMES participation, but due for follow-up. Between November and December, 2021, the average referral rate for patients who met category 1 criteria was 100%. There were no new diagnoses of T2DM during the implementation phase (January 3-February 28, 2022), so no post-implementation data were recorded for category 1. The average referral rate for category 2 patients improved from 3.45% pre-implementation to an average of 9.8% post-implementation. For category 3 patients, the average rate of reminder to schedule follow-up care increased from 0% pre-implementation to an average of 11.8% post-implementation. While these numbers fell short of the desired goal, improvement was made. Despite successful standardization of the referral process, lack of time, poor compliance with the algorithm, and patient declination of referral proved to be significant obstacles. A longer implementation period and integration of the algorithm into the EHR would likely improve provider compliance and increase utilization of DSMES for patients with T2DM.