Diabetes remains one of the most common chronic conditions seen in primary care clinics. While it remains one of the toughest quality measures to fulfill, it is crucial since we are approaching “Pay for Performance” in healthcare that will determine physician re-imbursement rates. We therefore performed this initiative to target patients within the internal medicine clinic at East Carolina University, who have a hemoglobin A1c (A1c) >9% (as this is suggested as a quality measure by Medicare’s Merit-based Incentive Payment System and the National Committee of Quality Assurance).

The 1st phase involved creating a protocol to identify/contact patients with an A1c >9%. The 2nd phase was to establish a diabetes clinic via a diabetes specialist within the primary care setting with the goal of providing individualized diabetes care for high-risk patients. The 3rd phase was to educate the residents on evidence-based diabetes management through yearly didactic sessions. The 4th phase was to establish a Diabetes Fellow clinic within the primary care clinic. We divided our results according to the level of training of the patients’ primary care provider (attending vs. resident).

On Mar 9, 2017, the clinic protocol identifying/calling patients with A1c >9% was initiated, the first diabetes clinic was on Sep 8, 2017, and the first diabetes fellow clinic was on July 30, 2018. Our initiative resulted in a reduction in the number of patients with A1c >9% in the resident clinic (30% vs. 22.6% vs. 20.9% in Feb 2017, Nov 2017, and Dec 2018 respectively) and the attending clinic (24% vs. 19.3% vs. 17.9% in Feb 2017, Nov 2017, and Dec 2018 respectively). Our clinic’s overall number of patients with A1c >9.0% improved from 21.6% in Nov 2017 to 20.02% in Dec 2018.

Our project has been successful in reducing the percentage of patients with an A1c >9%. Our project also reflects real-time attempts to improve clinic-wide glycemic control while continuously establishing care with new patients in a primary care clinic.


B.M. Mishriky: None. J.R. Powell: None. C.E. Holoman: None. M.R. Mian: None.

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