1176-P: The Value of Quality Improvement Programs in Diabetes Care: Experience from the Prime Program

The quality of diabetes care is suboptimal worldwide. The Joslin PRIME program assists healthcare professionals (HCPs) with improving diabetes outcomes using scalable quality improvement (QI) methodology. We present findings from a large-scale PRIME implementation focused on A1c reduction. An invitation was sent to 29 HCPs within a large multi-specialty medical group in Springfield, IL. Seventeen HCPs enrolled in the program. Each HCP identified a medical assistant or nurse within the practice to serve as the Diabetes Care Coordinator (DCC) and assist with leading QI activities. Following a live QI workshop, each team (HCP and DCC) learned how to create plan-do-study-act (PDSA) cycles, received a diabetes registry on patients with diabetes and established a plan to decrease the proportion of patients with A1c>9%. Teams were offered online CME, weekly support calls and guidance to implement QI activities using PDSA cycles. De-identified data including clinical metrics on all patients with diabetes, based on ICD-10 codes, cared for by 17 enrolled HCPs (EG) and 12 unenrolled HCPs (UG) were evaluated before and 5 months after institution of the program. Differences in proportion of patients with A1c>9% before the program (P1) and at 5 months (P2) were compared using Chi-square. Twelve participants completed at least one PDSA cycle and saw 39% of their patients with diabetes in 5 months, compared to 21% in the remaining participants. In the EG, P1 was 12% and P2 was 10% (p=0.037). In the UG, P1 was 11% and P2 was 10%, (p=0.136). The odds ratio of having A1c>9% was 0.79 (95% CI 0.63-0.99, p=0.037) in the EG and 0.86 (95% CI 0.71-1.05, p=0.136) in the UG. The proportion of patients with A1c>9% in the EG was significantly lower 5 months after institution of the program. Based on these preliminary data, the PRIME QI program, which is mostly delivered remotely, has the potential to assist HCPs to enhance the quality of diabetes care if applied at a larger scale.