Screening for Diabetes-Related Distress in an Outpatient Endocrine Clinic

Background: Identification and treatment of diabetes-related distress (DD) are essential for diabetes management, quality of life, and reducing health care costs for people with diabetes. There is no standardized workflow for DD screening in an outpatient endocrine clinic that manages approximately 2000 persons with diabetes. Aim: This quality improvement (QI) project aims to implement a DD screening and referral program in an outpatient endocrine clinic. Methods: The Mobilize, Assess, Plan, Implement, Track (MAP-IT) model was used to design the QI project. Patients without a diagnosis of diabetes, age less than 18 years, and pregnant women were excluded from the screening. DD was measured using the Problem Areas in Diabetes-5 (PAID-5) scale (0 - 20) points (1). An ambulatory systems analyst created a flowsheet in Epic for the PAID-5 questionnaire and routed the PAID-5 to MyChart. During the implementation phase, patients completed the PAID-5 on MyChart one week before their appointment or in-person during the encounter. Providers referred patients with a PAID-5 score ≥ 8 to a mental health provider (MHP). The primary outcomes were PAID-5 screening compliance and mental health referral compliance. Secondary outcomes include PAID-5 scores and hemoglobin A1C value percentage; changes in the PAID-5 scores and A1C values were compared pre- and post-intervention. Results: The project was implemented on August 31st, 2020. As of October 29th, 2020, the PAID-5 screening compliance was 66% (n = 385/585). The patient sample was 57% female and 43% male. It was identified that 113 (29%) patients had a PAID-5 score ≥ 8. Of these, only 33 (29%) patients received a referral to a MHP. Thirty-three patients (29%) refused a referral, and 5% were already seeing a MHP. Pre-intervention, the average PAID-5 score was 5, and the average baseline A1C value was 8% (< 5.7%). Conclusion: Based on the preliminary data, screening for DD in adults with diabetes utilizing the PAID-5 questionnaire is feasible and can facilitate the referral of distressed patients to mental health providers. Long-term implications for the practice change include a holistic and comprehensive approach to the management of diabetes and diabetes-related outcomes, including reduction of PAID-5 scores and A1C values in individuals referred to a MHP. References: (1) McGuire, B. E., Morrison, T. G., Hermanns, N., Skovlund, S., Eldrup, E., Gagliardino, J., Kokoszka, A., Mathews, D., Pibernik, M., Rodriguez, J., Wit, M., & Snoek, F. J. (2010). Short-form measures of diabetes-related emotional distress: The Problem Areas in Diabetes Scale (PAID)-5 and PAID-1. Diabetologia, 53(1), 66–69. https://doi.org/10.1007/s00125-009-1559-5