A Workflow Algorithm That Increases the Initiation of Continuous Glucose Monitors in a Rural Clinic

POSTER

A WORKFLOW ALGORITHM THAT INCREASES THE INITIATION OF CONTINUOUS GLUCOSE MONITORS IN A RURAL CLINIC Laura Dotson MSN, RN, DNP-AGNP Student Larry Garrett, PhD, MPH, RN, Nancy Allen PhD, ANP-BC, Glen Etzel, MD, and JoAnn Stout, CDE, RN Key Findings: This quality improvement project resulted in an increase in the number of continuous glucose monitors (CGM) initiated for patients with type 2 diabetes mellitus (T2DM) and using insulin by utilizing the workflow algorithm in a rural clinic. Results Background Rates of CGM Initiation: significantly increased from pre 17.4% (n=16/92) to post 33% (n=38/115) workflow algorithm implementation (p-value=0.0108). This was an 89% increase. Type 2 diabetes mellitus (T2DM) is a major health problem worldwide with the majority of patients never reaching or maintaining glycemic stability Usability: 100% (n=5) clinic staff reported using the algorithm either “all the time” or “most of the time” Regular self-monitoring of blood glucose (SMBG) has been shown to improve glucose levels and improve outcomes Feasibility: 100% (n=5) clinic staff reported the algorithm to be both “reasonable” and “easy to use” Numerous studies have demonstrated that CGM improves outcomes for patients with T2DM who use insulin Research has shown that there is a lag in CGM utilization by rural providers Satisfaction: 100% (n=5) clinic staff reported ”very satisfied” with the workflow algorithm. 88% (n=22/25) participating patients reported “very” or “somewhat” overall satisfaction Methods Barriers: Patient frustration with device failure or delay in prior authorization process was reported as a barrier by both clinic staff. A Quality improvement project to facilitate the initiation of CGM’s in a rural clinic. Facilitators: Learning that Initiation of CGM and interpreting results can be billed. A workflow algorithm was developed utilizing feedback from the primary physician, diabetes educator, office staff, and scholarly evidence-based articles. Conclusions There was a statistically significant increase in the number of CGM’s initiated during implementation of the workflow algorithm. Measured change in CGM initiation rates comparing pre to post workflow algorithm implementation. Post project surveys were distributed to evaluate project usability, feasibility, and satisfaction. Gaps in CGM initiation and race, gender, and insurance status of patients was evaluated. [Graph of results] The majority of patients who participated with CGM initiation reported better quality of care and an increase in their level of comfort with self management A second phase of this QI project will be beneficial to determine improvement in patient outcomes Potential useful resource for other rural clinics that underutilize CGM’s COLLEGE OF NURSING