Improving Diabetes Outcomes in a Primary Care Clinic During the COVID-19 Pandemic

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The prevalence of diabetes has increased over the last few decades due to changes in lifestyle and dietary habits and the worsening obesity epidemic. Diabetes leads to short-term and long-term complications, and it is the seventh leading cause of death in the United States. The management of diabetes is both complex and expensive and requires a partnership between the healthcare system and patients, supported by the community and payor organizations. Diabetes management aims to control blood sugar levels to near-normal levels, which requires lifestyle modification, self-monitoring, and medication. Social determinants of health increase the risk of diabetes and its complications, which makes certain communities more susceptible to diabetes and at higher risk of complications and poor control. There are multiple models to manage diabetes in primary care, including the chronic disease module using a team-based approach. This paper describes a diabetes quality improvement project using team-based care and workflow re-design during the Covid 19 pandemic in an academic public health setting. The project was conducted in multiple PDSA cycles and was implemented from January 1, 2021, to December 31, 2021, in the EHC primary care clinic. The clinic cares for a diverse population of patients with over 100 spoken languages, mostly uninsured and underinsured immigrants. The clinical staff consists of 30 physicians, 16 nurse practitioners, clinical pharmacists, dietitians, and social workers. The diabetes registry includes all patients aged 18-75 with a diagnosis of diabetes who had a primary care visit within the 18 months period. EHC had 5100 patients diagnosed with diabetes at the beginning of the quality improvement project; 2200 were considered uncontrolled with HbA1c more than eight or missing lab results. The project improved the diabetes outcome measured as HbA1c level less than eight from 55.6% to 67.6% at the end of the quality improvement period.



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