In collaboration with the ADA, we implemented a QI project to improve glycemia in patients with type 2 diabetes (T2D) and poor glycemic control (A1C > 9%) receiving care in a large urban safety net health system. The 18-month initiative focused on developing shared medical appointments for insulin initiation and management, supported by a primary care QI committee, educational interventions and development of EMR tools to facilitate diabetes management and documentation. We report 2-year data following implementation of the QI intervention.
Of 23,611 individuals (mean age 58 years) with 73,849 A1C data points over a period of 3 years 60% were female; 57% Hispanic white, 27% non-Hispanic Black, 9% non-Hispanic white; 62% received charity care, 30% Medicare/Medicaid, 5% commercial insurance. Control charts first demonstrated statistically significant increases in insulin use in poorly controlled patients followed by statistically significant improvement in population glycemic control (A1C average) and proportion of patients with A1c>9% (see figure).
A primary care-based QI initiative targeting patients with T2D and A1C > 9% led to appropriate increases in insulin prescriptions, which was followed by a system-wide improvement in diabetes control.
U. Gunasekaran: None. R.E. Furman: Consultant; Self; Novo Nordisk Inc.. K.M. Rodriguez: None. E. Obialo: None. S. Kassa: None. N.O. Santini: None. E. Furman: None. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association.