| Description |
Primary care providers bear the majority of the responsibility for the ongoing management of the costly, disabling, and deadly chronic disease, type 2 diabetes mellitus (T2DM). A preponderance of evidence demonstrates that diabetes management guidelines improve patient outcomes; however, primary care providers have inconsistent or poor adherence to guidelines, resulting in significant gaps between evidence-based and actual care for people with T2DM. Barriers to optimal care include limited appointment times, lack of ready access to patient information, and inadequate knowledge of guideline recommendations. The objectives of this project were to expand the use of the electronic health record (EHR) to incorporate T2DM management guidelines and to structure clinic workflow for efficient evidence-based care at Idaho Minor Emergency and Family Practice, a small primary care clinic, and to disseminate project results to a wider audience. Core functions of the EHR include effective care delivery, facilitation of chronic disease management, improved efficiency, and enhanced patient safety; yet, studies of the effect of the EHR on quality of care reveal mixed results. Researchers agree that EHR use does not guarantee superior care, but that advanced functions such as decision support and registry activation make the EHR invaluable. Small clinics struggle with optimal use of advanced EHR functions. In addition to an optimized EHR, other changes, such as workflow modification, are required to improve diabetes care, and can mitigate providers' barriers to optimal care. For this project, I expanded use of the EHR for management of patients with T2DM by inserting a guideline-based diabetes order set and by activating the Diabetes Registry, Clinical Decision Support System alerts, and the Diabetes Flowsheet. Furthermore, I configured workflow to meet guideline recommendations and to integrate clinic staff as team members. I incorporated provider feedback into the changes, and surveyed the providers to assess usability and satisfaction. As a result of this project, collaborations were developed with federal and local quality-improvement organizations. Providers were highly satisfied with the project and stated their intention to incorporate the EHR tools and workflow changes into their practice. Results were disseminated through submission of an abstract to a Sigma Theta Tau and acceptance for oral presentation at a national convention, and presentation to Saint Alphonsus Health Alliance, a multistate, clinically integrated network of providers. Management of T2DM in primary care is complex. Optimized EHR use and workflow can reduce barriers to evidence-based care, including lack of time, lack of access to patient information, and lack of knowledge of guidelines. Collaboration with federal and private organizations can assist small clinics toward continuous quality improvement and improved outcomes for patients with T2DM. |
