Aim: Using lean six sigma QI tools, Define-Measure-Analyze-Improve-Control (DMAIC), design and implement best practices to reduce percentage of patients with hgbA1c >9.0% from baseline of 26% in May 2018 to 21% by July 2019 in our endocrinology clinic.

Methods: We used institution’s diabetes registry to capture hgbA1c values and patient visits to endocrinology clinic. DMAIC data driven improvement cycle was used for identifying care gaps, problem solving and interventions to improve workflow processes. At the end of the DMAIC implementation, Plan-Do-Study-Act (PDSA) cycles were implemented for 6 months for control of the new processes. During Analyze phase, main care gaps identified were missing hgbA1c values, appointment cancellations and low participation in self-management diabetes education. We implemented pre visit planning, standardization of hgbA1c ordering process, standing medical orders for both hgbA1c testing and self-management diabetes education classes. DMAIC phases were completed over five months, and the process was monitored for next six months.

Results: 3016 persons were seen for diabetes management during the measurement period. Percent in poor control improved from 26% in May 2018 to 18% by July 2019.

Conclusion: Quality improvement tools can be successfully applied to improve and sustain clinical outcomes such as hgbA1c control in persons with diabetes.


S. Ali: None. U. Kollipara: None.

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