Implementing a Diabetes Education Referral Toolkit: An Evidence-Based Quality Improvement Project

Background: Diabetes affects over 38.4 million Americans, with significant disparities in healthcare access and outcomes among racially and ethnically diverse populations. Despite the benefits of diabetes education, only 6.8% of patients receive it within the first year of diagnosis. Barriers such as provider time constraints, unclear referral processes, and insurance complexities hinder referrals for diabetes education. Addressing these challenges is essential to improving diabetes management and outcomes. Local Problem: In Salt Lake City, the diabetes prevalence rate is 9.1%, with economically disadvantaged and racially diverse populations experiencing a higher burden of the disease. At an academic family health clinic in Salt Lake City serving a diverse patient population, diabetes education referral rates were lower than desired. Barriers to referral included a cumbersome referral system, limited provider awareness of available resources, and challenges related to insurance coverage, preventing timely access to diabetes education for patients. Methods: A quality improvement initiative guided by the Johns Hopkins Evidence-Based Practice model was implemented. A pre-intervention survey assessed provider knowledge and referral practices, and a retrospective chart review established baseline referral rates. The intervention involved developing a diabetes education referral toolkit, conducting provider training, and evaluating its impact through post-intervention surveys and referral data analysis over a 12-week period. Interventions: The diabetes education referral toolkit included a workflow algorithm, billing guide, pre-written electronic health record (EHR) templates, and a dot phrase (.diabetesresources) for quick access to referral information. An in-person training session introduced the toolkit, emphasizing its benefits and the referral process. Toolkit materials were provided in both print and electronic formats. Results: Baseline referral rates for diabetes education were 5.64%. Post-intervention, the referral rate decreased slightly to 5.33%, with no statistically significant change (p = 0.77). Most providers (80%) reported the toolkit was easy to use, and satisfaction was high (80%). The EHR templates and dot phrase were identified as the most helpful components. Provider feedback indicated increased awareness of the referral process and insurance requirements but highlighted ongoing challenges with patient engagement and insurance complexities. Conclusion: Although the toolkit did not significantly increase referral rates, it was well received by providers and improved clarity around the referral process. Positive feedback suggests potential for longer-term benefits if supported by ongoing training and provider engagement. Future efforts should focus on sustainability, addressing patient-related barriers, and exploring strategies to enhance provider perceptions of their role in promoting diabetes education.