| Description |
Background: Despite the proven benefits of diabetes self-management education (DSME) programs, only 5% of Utah's adult diabetes population has participated in such programs, largely due to a shortage of referrals from healthcare providers. Insurance coverage for these services typically requires a referral from a provider. Barriers to referrals include gaps in provider knowledge and inefficient clinic processes. Local Problem: In Davis County, Utah, there are five diabetes education programs that are underutilized, with fewer than 13% of eligible individuals being referred to these programs in the majority of primary care clinics. This quality improvement project aimed to develop an effective referral process and increase patient referrals to local diabetes education programs through a new referral toolkit for healthcare providers. Methods: This project was conducted at two primary care clinics in Davis County, Utah. A systematic literature review and site assessments via pre-surveys and interviews revealed issues with referral processes and provider knowledge gaps regarding diabetes education programs. Next, a comprehensive diabetes education referral toolkit was developed, including an informational brochure for providers, fax referral templates, and patient education materials in English and Spanish. Pre-surveys through the REDCap database collected participant demographics from eight providers and two nurses and recorded referral frequencies and barriers. Post-intervention surveys were conducted with monetary incentives at three, 14-, and 30 days post-distribution. Descriptive data collection included participant knowledge, referral frequency, toolkit usability, feasibility, satisfaction, and perceived barriers. Results: Participant referrals to diabetes education programs increased significantly by an average of 36.5%, from 25.75% pre-intervention to 62.3% 30 days post-intervention (p<0.05). On average, each participant sent 15.25 patient referrals over 30 days, with moderate variability (sd≈6.40), and no participants referred fewer than five patients post-intervention. A resounding 90% (n=9) of participants expressed satisfaction with the toolkit, attributing improved awareness of local diabetes education programs (9, 90%), enhanced patient education (7, 70%), and time efficiency (9, 90%) to its use. Additionally, all ten participants expressed their intention to continue using the toolkit, affirming its sustainability. Conclusions: The referral toolkit intervention enhanced participant knowledge of diabetes education services, increased referral frequencies, and improved clinic referral processes. The results of this project support the evidence that primary care provider interventions can increase DSME referrals and patient access to diabetes education in the community. Future research should explore automated referral integration with electronic health record systems to facilitate targeted outreach to eligible patients. |
