Enhancing the Patient Experience with Follow-Up Diabetes Care while Increasing Efficiencies Using Quality Improvement Methods

Introduction: Patients with poorly-controlled diabetes often visit the emergency department (ED) for treatment of hyperglycemia. While previous qualitative studies have examined the patient experience of diabetes as a chronic illness, there are no studies describing patients’ perceptions of ED care for hyperglycemia. The objective of this study was to explore the patient experience regarding ED hyperglycemia visits, and to characterize perceived barriers to adequate glycemic control post-discharge. Methods: This study was conducted at a tertiary care academic centre in London, Ontario. A qualitative constructivist grounded theory methodology was used to understand the experience of adult patient partners who have had an ED hyperglycemia visit. Patient partners, purposively sampled to capture a breadth of age, sex, disease and presentation frequency were invited to participate in a semi-structured individual interview to probe their experiences. Sampling continued until a theoretical framework representing key experiences and expectations reached sufficiency. Data were collected and analyzed iteratively using a constant comparative approach. Results: 22 patients with type 1 or 2 diabetes were interviewed. Participants sought care in the ED over other options because of their concern of having a potentially life-threatening condition, advice from a healthcare provider or family member, or a perceived lack of convenient alternatives to the ED based on time and location. Participants’ care expectations centred around symptom relief, glycemic control, reassurance and education, and seeking referral to specialist diabetes care post-discharge. Finally, perceived system barriers that challenged participants’ glycemic control included affordability of medical supplies and medications, access to follow-up and, in some cases, the transition from pediatric to adult diabetes care. Conclusion: Patients with diabetes utilize the ED for a variety of urgent and emergent hyperglycemic concerns. In addition to providing excellent medical treatment, ED healthcare providers should consider patients’ expectations when caring for those presenting with hyperglycemia. Future studies will focus on developing strategies to help patients navigate some of the barriers that exist within our current limited healthcare system, enhance follow-up care, and improve short- and long-term health outcomes.

Download Full-text

Trends in the process and outcome indicators of type 2 diabetes care: a cohort study from Eastern Finland, 2012–2017

BMC Family Practice ◽

10.1186/s12875-020-01324-5 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Marja-Leena Lamidi ◽

Katja Wikström ◽

Laura Inglin ◽

Päivi Rautiainen ◽

Hilkka Tirkkonen ◽

...

Keyword(s):

Type 2 Diabetes ◽

Quality Improvement ◽

Diabetes Care ◽

Target Level ◽

Outcome Indicators ◽

Treatment Targets ◽

Process And Outcome ◽

Process And Outcome Indicators

Abstract Background Evidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care. Quality improvement can be evaluated by monitoring longitudinal trends in the care indicators on the system level. The aim of this study is to describe trends in the processes and outcomes of care among people with type 2 diabetes in North Karelia, Finland. Methods The data consist of all adults with type 2 diabetes (identified from the EHRs using ICD-10 codes) who used primary or specialized care services in North Karelia during 2012–2017. The diabetes care was evaluated using the measurement activity, treatment levels, and the achievement of the treatment targets for HbA1c and LDL as care indicators. Logistic and linear models with generalized estimating equations were used to assess the differences between years, sexes, and age groups. Results The proportion of patients with annual measurement varied between 75.8 and 78.1% for HbA1c and between 67.4 and 69.1% for LDL during a five-year follow-up. The changes in average levels were moderate: a 0.2% (2 mmol/mol) increase for HbA1c and a 0.1 mmol/l decrease for LDL. Anyway, the proportion of patients meeting the treatment target for HbA1c decreased from 72.7 to 67.3% (age-adjusted decrease: 5.7%p, 95% CI: 4.5–6.9) and for LDL it increased from 53.4 to 59.5% (age-adjusted increase: 5.6%p, 95% CI: 4.2–7.0). Women were measured and met the HbA1c target level more often compared with men. Conversely, men met the LDL target level more often than women, and the age-adjusted difference between sexes increased smoothly from 7.9%p to 11.7%p. Conclusions The achievements in relation to type 2 diabetes care in North Karelia are very good, but no major improvement was observed during follow-up. HbA1c levels had a rising tendency and LDL levels declining tendency indicating quality improvement in LDL management, but challenges in further improvement in glucose control.

Download Full-text

Continued Follow-Up by a Hospital Diabetes Care Team Improves HbA1c at 1 Year after Elective Orthopedic Surgery

Diabetes ◽

10.2337/db18-2317-pub ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2317-PUB

Author(s):

RAJESH GARG ◽

SHREYA BHANDARI ◽

RAQUEL REIN ◽

MARIE E. MCDONNELL

Keyword(s):

Orthopedic Surgery ◽

Diabetes Care ◽

Care Team

Download Full-text

1174-P: Reducing Lost to Follow-Up Rates in the T1D Exchange Quality Improvement Collaborative (T1DX-QI)

Diabetes ◽

10.2337/db20-1174-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1174-P

Author(s):

RYAN MCDONOUGH ◽

SARAH THOMAS ◽

NICOLE RIOLES ◽

OSAGIE EBEKOZIEN ◽

MARK A. CLEMENTS ◽

...

Keyword(s):

Quality Improvement ◽

Quality Improvement Collaborative ◽

Lost To Follow Up

Download Full-text

Quality improvement methodology to improve patient experience and transforming transplant service delivery

10.26226/morressier.5a38ffa4d462b8029238b4e7 ◽

2018 ◽

Author(s):

Roshni Rathore

Keyword(s):

Quality Improvement ◽

Service Delivery ◽

Patient Experience ◽

Improve Patient

Download Full-text

An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

BMJ Open Quality ◽

10.1136/bmjoq-2019-000839 ◽

2021 ◽

Vol 10 (2) ◽

pp. e000839

Author(s):

Heather Cassie ◽

Vinay Mistry ◽

Laura Beaton ◽

Irene Black ◽

Janet E Clarkson ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Case Studies ◽

Quality Care ◽

Theoretical Domains Framework ◽

Team Members ◽

Knowledge And Skills ◽

Scottish Government ◽

The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

Download Full-text

Telemedicine Foot and Ankle Visits in the COVID-19 Era

Foot & Ankle Orthopaedics ◽

10.1177/2473011421994068 ◽

2021 ◽

Vol 6 (1) ◽

pp. 247301142199406

Author(s):

Sameh A. Labib ◽

Rahul Goel ◽

Wesley Manz ◽

Jason Bariteau

Keyword(s):

Patient Experience ◽

Expert Opinion ◽

Foot And Ankle ◽

Office Visits ◽

Level Of Evidence ◽

Excellent Care ◽

Musculoskeletal Care

Background: The COVID-19 pandemic created a difficult environment to provide musculoskeletal care to patients with foot and ankle pathology given the limitations placed on in-office visits. Telemedicine offered a unique avenue to reach these patients; however, the efficacy of telemedicine visits in patients with foot and ankle pathology is not well studied. We propose a telemedicine protocol that has allowed us to effectively see and treat patients with foot and ankle pathology. Methods: A 12-step standardized telemedicine protocol was created within the Foot and Ankle division that was used for seeing patients through telemedicine. Also included in this is previsit preparation and follow-up recommendations. Press Ganey surveys were retrospectively reviewed to understand patient experience with telemedicine. Results: 85.2% of patients surveyed responded with scores indicating excellent care. When comparing patients who were seen in-office and through telemedicine, 89.2% and 83.4% responded with scores indicating excellent care, respectively ( P = .37). Conclusion: Telemedicine offers an effective and convenient way to provide excellent musculoskeletal care to patients affected with foot and ankle pathology. This is the first study that evaluated a comprehensive protocol for telemedicine encounters and can be used to implement telemedicine by others using this approach. Level of Evidence: Level V, expert opinion.

Download Full-text

A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

Japanese Clinical Medicine ◽

10.4137/jcm.s39766 ◽

2016 ◽

Vol 7 ◽

pp. JCM.S39766 ◽

Cited By ~ 1

Author(s):

Noriko Satoh-Asahara ◽

Hiroto Ito ◽

Tomoyuki Akashi ◽

Hajime Yamakage ◽

Kazuhiko Kotani ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Care ◽

Clinical Pathways ◽

Coping Resources ◽

Care Providers ◽

Depression Care ◽

Patients With Diabetes ◽

And Coping ◽

Levels Of Integration

Purpose Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. Method We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. Results Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. Conclusion A new PHR may be suitable for comorbid patients with diabetes and depression.

Download Full-text

Do quality improvement initiatives for diabetes care address social inequities? Secondary analysis of a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-018826 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018826 ◽

Cited By ~ 5

Author(s):

Jacquie Boyang Lu ◽

Kristin J Danko ◽

Michael D Elfassy ◽

Vivian Welch ◽

Jeremy M Grimshaw ◽

...

Keyword(s):

Systematic Review ◽

Socioeconomic Status ◽

Quality Improvement ◽

Diabetes Care ◽

Secondary Analysis ◽

Place Of Residence ◽

Disadvantaged Groups ◽

Disadvantaged Populations ◽

Patients With Diabetes ◽

Race Ethnicity

BackgroundSocially disadvantaged populations carry a disproportionate burden of diabetes-related morbidity and mortality. There is an emerging interest in quality improvement (QI) strategies in the care of patients with diabetes, however, the effect of these interventions on disadvantaged groups remains unclear.ObjectiveThis is a secondary analysis of a systematic review that seeks to examine the extent of equity considerations in diabetes QI studies, specifically quantifying the proportion of studies that target interventions toward disadvantaged populations and conduct analyses on the impact of interventions on disadvantaged groups.Research design and methodsStudies were identified using Medline, HealthStar and the Cochrane Effective Practice and Organisation of Care database. Randomised controlled trials assessing 12 QI strategies targeting health systems, healthcare professionals and/or patients for the management of adult outpatients with diabetes were eligible. The place of residence, race/ethnicity/culture/language, occupational status, gender/sexual identity, religious affiliations, education level, socioeconomic status, social capital, plus age, disability, sexual preferences and relationships (PROGRESS-Plus) framework was used to identify trials that focused on disadvantaged patient populations, to examine the types of equity-relevant factors that are being considered and to explore temporal trends in equity-relevant diabetes QI trials.ResultsOf the 278 trials that met the inclusion criteria, 95 trials had equity-relevant considerations. These include 64 targeted trials that focused on a disadvantaged population with the aim to improve the health status of that population and 31 general trials that undertook subgroup analyses to assess the extent to which their interventions may have had differential impacts on disadvantaged subgroups. Trials predominantly focused on race/ethnicity, socioeconomic status and place of residence as potential factors for disadvantage in patients receiving diabetes care.ConclusionsLess than one-third of diabetes QI trials included equity-relevant considerations, limiting the relevance and applicability of their data to disadvantaged populations. There is a need for better data collection, reporting, analysis and interventions on the social determinants of health that may influence the health outcomes of patients with diabetes.PROSPERO registration numberCRD42013005165.

Download Full-text