| Description |
Type 2 diabetes mellitus (T2DM) is a large and growing epidemic in the United States, leading to significant morbidity, mortality, and enormous healthcare costs. Despite this epidemic, little has been done in the healthcare system to assist with diabetes prevention. Appropriate treatment, including lifestyle intervention and/or medication, during the prediabetes stage is critical in reducing the individual's risk of progressing to T2DM. Unfortunately, the literature strongly indicates the healthcare system as a whole is performing at an alarmingly poor level in regards to prediabetes care. The poor performance is, in large part, due to those with prediabetes going undiagnosed, and therefore not given an opportunity to be treated with medication, if indicated, or make necessary lifestyle modifications. Furthermore, even individuals diagnosed with prediabetes are not being adequately treated. Ideally, patients with prediabetes are referred to a comprehensive diabetes prevention program, but these programs are often not widely accessible, due to geographic location and/or cost. Primary care providers hold the main responsibility for identifying and providing treatment for those with prediabetes, and without the availability of diabetes preventions programs, their workload is significantly increased. This project aimed to improve prediabetes identification and treatment within a rural family practice setting. First, to improve providers' knowledge of current prediabetes management guidelines, an educational in-service was completed. A pre and post-test survey (n=4) revealed that reported provider knowledge of prediabetes management rose significantly following the presentation (pre-test mean 3.96 ±0.6; post-test mean 4.75 ±0.3; p= 0.01). In order to improve the providers' clinical use of recommended management guidelines, a prediabetes management algorithm was developed to help guide clinical decision-making. The algorithm was provided in print and integrated into the clinic's electronic health record (EHR) system for ease of access. Additionally, an EHR order set was created to assist with efficiency and accuracy of orders and documentation. A survey was administered following the implementation of these tools and revealed that not only were the providers satisfied with the tools (mean 4.63 ±0.75) but they also expressed a positive likelihood of continuing to use them in their future practice (mean 4.5 ±1.0). Lastly, to assist the clinic in maintaining continuous quality improvement initiatives for their prediabetes population, a reporting method was developed within the clinic's EHR system, which characterized the clinic's current prediabetes population, allowed performance to be assessed, and allowed patients to be identified to provide resources and treatment. Prediabetes offers an important window of opportunity for treatment to reduce an individual's risk of developing T2DM, and the subsequent complications and healthcare cost. Interventions aimed at improving primary care providers' ability to identify and appropriately treat prediabetes are needed. Educating primary care providers, offering simple clinical tools, and assisting clinics with sustainable quality improvement initiatives are the initial interventions needed to work towards a healthcare system that recognizes and values the importance of appropriate prediabetes care. |
