Diabetic Bundle Implementation to Improve Clinical Quality Measures: A Quality Improvement Project

Background: In the United States, approximately 34.2 million adults over 18 years of age have diabetes. In Utah alone, over 180,000 adults over the age of 20 years have type 2 diabetes mellitus (T2DM). Diabetes is costly; about $245 billion each year is spent on care directly or indirectly related to diabetes. With the onset of the COVID-19 pandemic, rates of T2DM have increased, and care delivery practices have had to change to properly treat and support individuals in the timely management of their diabetes screening exams. The Madsen Family Health Center (MFHC), an urban, primary care clinic in Utah designed a quality improvement project to support patients with diabetes during the COVID-19 pandemic. The aim of this project was to implement a dotphrase, .diabeticbundle, in the electronic health record used at MFHC. The intent was to increase rates of screening and improve clinical quality measures (i.e., hemoglobin A1c, blood pressure, statin medication use, and urine microalbumin). Methods: We first presented this project at MFHC's monthly clinical quality meeting and sent out a pre-intervention survey to assess current diabetes screening practices. We worked with electronic health record (EHR) informatics specialists to implement and track dotphrase use and any changes in the clinical quality measures. After three months, a post-implementation survey was sent to assess usability, feasibility, and satisfaction of MFHC's healthcare professionals (HCP). Analysis was completed of data collected from the EHR. Results: A statistically significant increase in use of the dotphrase post-intervention was demonstrated, p > .001. Pre-intervention the 455 patients with T2DM who had established care at MFHC, 38% were considered controlled in all four clinical quality measures: hemoglobin A1c, blood pressure, statin medication use, and urine microalbumin. Post-intervention, by December 2021, patient numbers increased to 470 individuals with 41.06% of patients considered controlled in all four clinical quality measures within the diabetic bundle. The majority of HCPs expressed that the dotphrase was easy to use (feasibility), it helped improve patient care and clinical quality measures (usability), and plan to continue using the dotphrase long-term (satisfaction). Conclusions: Post-intervention, the dotphrase was used more frequently, and it became a part of some HCP's practice habits. Using the dotphrase improved diabetic bundle clinical quality measures, including hemoglobin A1c, blood pressure, statin medication use, and urine microalbumin. It can be reasonably presumed that long-term use of the dotphrase will increase patient screening rates which in turn, may improve patient health outcomes related to T2DM.