Introduction: To compare our diabetes clinic’s baseline adherence to American Diabetes Association (ADA) and International Society of Pediatric and Adolescent (ISPAD) guidelines for obtaining urine creatinine/albumin ratio (ACR), liver enzymes (LFTs) and lipids at diagnosis with type 2 diabetes (T2D) to the rates of screening adherence following institution of educational flowcharts, revised note templates, and a best practice advisory (BPA).
Methods: Data was extracted from Epic including all patients seen initially in our diabetes outpatient clinic with recently diagnosed T2D from 7/2014-8/2019. Data included dates of initial patient visits to our clinic and dates of ACR, LFTs, and lipid order placement or previous lab results. Vizio flowcharts and a revised clinic note template reflecting ADA/ISPAD guidelines were created and presented to the clinic’s 8 attendings and 5 APNPs in 7/2016. In 10/2017, a BPA alert containing the recommended labs began firing if T2D was on the patient’s problem list. A provider was considered adherent to the guidelines if labs were available from the previous 6 months or ordered within 120 days of diagnosis. Pre and post-screening rates were compared using the t-test.
Results: Analysis included 40 patients diagnosed with T2D before any interventions and 39 after the 10/2017 BPA began. The improvement in urine ACR ordering rate was significant as it went from a baseline of 32.5% up to 82.1% (p<0.001), while improvements in the LFT ordering rate (60.0% up to 74.4%; p=0.2) and the lipid order rate (70.0% up to 79.0%; p=0.4) were not significant.
Conclusion: With the implementation of the T2D flowchart, templated note, and BPA, adherence to ADA/ISPAD of ordering baseline screening labs rose to the 70-80% range. Given our aim to detect and treat complication as early as possible, and in order to increase reliability of our care, we are going to begin posting quarterly run charts so both the ordering provider and the diabetes nurses are consistently updated on our adherence rates.
P. Singh: None. P. Wolfgram: None.
