1266-P: Diabetes INSIDE: Improving Population HbA1c Testing and Targets in Primary Care with QI

As a participant in the ADA’s Diabetes INSIDE program, a 19-member multidisciplinary QI team identified care quality gaps after reviewing 6 years (1/2010 to 5/2016) of EHR data on 3,136 T2DM outpatients seen by 190 PCPs in an urban academic medical center. The team set goals to increase HbA1c testing frequency (reduce 45% of patients with HbA1c intervals > 6 months) and to reduce HbA1c levels in both the overall population and patients with HbA1c > 9%. Implemented strategies included 1) a provider outreach program of departmental and individualized actionable data reports of HbA1c testing intervals and outcomes, 2) a patient outreach program to address individual timely follow-up care, 3) a patient awareness campaign to improve understanding of following and improving clinical outcomes, 4) improving structured EHR data capture to improve population monitoring, and 5) standardizing workflow across clinics for pre-visit planning, patient outreach, patient education, checking completion of appointment goals, and post-visit follow-up.

Eight-years of EHR follow-up data (1/2010 to 5/2018) on 7,798 patients (mean age 61 years, 57% female, 62% black, 97% insured) with 136,004 visits showed target improvements. Population characteristics were stable over time. A department-stratified Cox proportional hazards model controlling for age, gender, race, and HbA1c level showed a statistically signification 20% reduction in HbA1c testing intervals > 6 months (HR = 1.20±0.07). Statistical process control charts (6 years pre- and 2 years post-intervention) showed statistically significant 15.5% relative improvement in the patient proportion with HbA1c > 9% from 13% to 11% following QI interventions and a significant 2.1% improvement of population mean HbA1c from 7.4% to 7.2%.