Increasing Screening for Type 2 Diabetes Mellitus in the Native American Population

Background: An estimated 451 million people are living with diabetes worldwide (Cho, 2018). In 2017, five million deaths worldwide were attributed to diabetes (Cho, 2018). Local Problems: Native American adults are three times more likely to be diagnosed with diabetes than non-Hispanic white adults (Xu et al., 2016). Increased screening is needed to confront health inequities for the Native American population in this rural clinic (Adakai et al., 2018). Methods: A quality improvement project was developed to assist with increasing the screening rates of Native American adults in the rural, tribal clinic. Pre-intervention screening rates were assessed and compared to post-intervention screening rates at the end of a six-week implementation period. Interventions: All adults who presented to the clinic were screened for their risk for developing type 2 diabetes mellitus, receiving hemoglobin A1c testing per the screening protocol. A screening tool was selected and providers in the clinic were educated on its use. Data was collected on how many patients were screened and compared to data collected prior to intervention implementation. Post-implementation surveys were administered to the providers to determine the feasibility and usability of the tool for continued practice. Results: The screening rate for type two diabetes mellitus in the clinic increased after intervention of the screening protocol. The change in percentages of patients screened was found to be statistically significant. Feasibility, usability, and provider satisfaction were confirmed using a survey of provider experience. Conclusion: The screening protocol increased the screening rate for type 2 diabetes mellitus and was determined to be feasible and usable for providers in this rural primary care setting that cares for the high- risk, Native American population. Replication of this quality improvement project is needed to determine if screening rates and provider experience would be improved in other, larger, settings.