scholarly journals Assessment of Glycemic Control at St. Luke's Free Medical Clinic: A Retrospective Chart Review (Preprint)

10.2196/31123 ◽  
2021 ◽  
Author(s):  
Wade Hopper ◽  
Justin Fox ◽  
JuliSu Dimucci-Ward
Keyword(s):  
Glycemic Control ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Medical Clinic

Assessment of Glycemic Control at St. Luke’s Free Medical Clinic: A Prospective-Retrospective Chart Review (Preprint)

2021 ◽  
Author(s):  
Wade Hopper ◽  
Justin Fox ◽  
JuliSu Dimucci-Ward
Keyword(s):  
Glycemic Control ◽  
Chart Review ◽  
Hemoglobin A1c ◽  
Care Delivery ◽  
Retrospective Chart Review ◽  
National Standards ◽  
Rank Test ◽  
Medical Clinic ◽  
Free Clinic ◽  
Uninsured Patients

BACKGROUND The free clinic is a health care delivery model that provides primary care and pharmaceutical services exclusively to uninsured patients. Using a multidisciplinary volunteer clinical staff which includes physicians, social workers, dieticians, and osteopathic medical students, St. Luke’s Free Medical Clinic (SLFMC) cares for over 1,700 patients annually in Spartanburg, SC. OBJECTIVE This study aims to measure the change, over time, in patient A1c measurements at SLFMC in order to quantify the success of the clinic’s diabetes treatment program. METHODS A prospective-retrospective chart review of patients enrolled at St. Luke’s between January 1, 2018, and January 1, 2021 (n=140) was performed. Patients were stratified as having controlled (<7.0 A1c, n=53) or uncontrolled (≥7.0 A1c, n=87) diabetes relative to a therapeutic A1c target of 7.0 recommended by the American Diabetic Association. For both controlled and uncontrolled groups, baseline A1c values were compared to subsequent readings using a Wilcoxon matched-pairs signed rank test. Results from the SLFMC population were compared to published A1c literature from other free clinics. RESULTS Patients with uncontrolled diabetes experienced significant reductions in median A1c at both 6 months (p=.006) and 1 year (p=.002) from baseline. Patients with controlled diabetes showed no significant changes. SLFMC’s wholly uninsured patient population showed a population rate of controlled diabetes (42%) that came close to recent national averages for adults with diabetes (51% to 56%) as published by the National Health and Nutrition Examination Survey (NHANES). The clinic’s Hispanic population (n=47) showed the greatest average improvement in A1c from baseline of any ethnic group. Additionally, 61% of SLFMC’s Black population (n=33) achieved an A1c under 7.0 by the end of the study window, which surpassed national averages for glycemic control. CONCLUSIONS We present free clinic hemoglobin A1c outcomes obtained through chart review. Uninsured patients treated for diabetes at SLFMC show a reduction in hemoglobin A1c that is comparable to national standards although average A1c levels were higher than national averages. Black and Hispanic populations that are more highly represented in the uninsured pool performed well under SLFMC management. These results represent some of the first in the literature to come from a free clinic that is not affiliated with a major medical school.

scholarly journals Association of vitamin d with glycemic control in Saudi patients with type 2 diabetes: A retrospective chart review study in an emerging university hospital

2019 ◽  
Vol 34 (2) ◽  
Author(s):  
Khaled K. Al Dossari ◽  
Gulfam Ahmad ◽  
Abdulrahman Aljowair ◽  
Naif Alqahtani ◽  
Mohammed Bin Shibrayn ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Glycemic Control ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Review Study ◽  
Saudi Patients

scholarly journals Improving Glycemic Control of Diabetic Patients in an Outpatient Practice

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A333-A333
Author(s):  
Otto T Gibbs ◽  
Gene C Otuonye ◽  
Ahmed H Sammour ◽  
Marnie Aguasvivasbello ◽  
Karlene D Williams
Keyword(s):  
Glycemic Control ◽  
Low Income ◽  
Chart Review ◽  
Tracking System ◽  
Quality Care ◽  
Retrospective Chart Review ◽  
Economic Cost ◽  
Diabetic Patients ◽  
Documentation System ◽  
Electronic Prescription

Abstract Diabetes Mellitus (DM) is a devastating condition with premature mortality, poor quality of life, & vast economic cost contributing to substantial societal burden. More resources are allocated to DM than any other condition, & with an estimated worldwide prevalence of 350 million people by 2025, it remains an urgent epidemic. Providing standardized, high quality care (HQC) to improve DM control is a matter of utmost importance. Our residents receive primary care training in a federal funded healthcare system, with yearly reports from Medicare addressing compliance with current accepted standards, including but not limited to DM management. In this Quality Improvement (QI) project, we sought to directly address deficiencies in their management. A retrospective chart review was conducted over 1 year. Patients with uncontrolled (UC) DM were identified & a root cause analysis conducted. It was noted that over 40% of diabetics were UC, with a hemoglobin A1c (HbA1c) &gt;8%; 60% of whom did not have appropriate escalation of management (AEOM) in further encounters. A QI intervention was developed aiming to improve AEOM in patients. Plan-Do-Study-Act cycles focused on the creation of a standardized documentation system (SDS) for UC DM encounters, a tracking system & a designated “DM manager”, who ensured electronic prescription delivery & early follow-up (F/U) appointments. Clear metrics of AEOM were established & clinicians underwent small group educational sessions emphasizing each intervention, with review of updated ADA guidelines. Although prospective biweekly chart review is ongoing, Fisher’s exact test was used for statistical analysis of initial post interventional data. A total of 33 UC DM patient encounters were analyzed thus far. In January 2020, 31% of all encounters used the newly created SDS; of which 69% had AEOM. In February 2020, 57% of all encounters used the SDS; 71% of providers had AEOM. Of the encounters using the SDS, 83% had AEOM compared to 67% in those without (p:0.42). Average F/U time per patient was 6 weeks. Delivering standardized & HQC in DM patients presents a challenge dependent on a variety of system & patient factors. This becomes more apparent in rural & low-income populations as in our clinic. Although HbA1c is a well-established method of monitoring glycemic control, we propose that other uniform performance measures be used to dynamically assess overall DM management. Our metrics include standardized, replicable documentation, early F/U time & defined AEOM parameters such as timely addition of new medication, dose adjustments, & utilization of resources such as DM educators. Thus far, there appears to be a non-statistically significant trend towards improved standardization of provider documentation, F/U visits & AEOM. Further data is needed. We hope to see these measures translate into overall improved glycemic control.

Glycemic Control in Adult Surgical Patients Receiving Regular Insulin Added to Parenteral Nutrition vs Insulin Glargine: A Retrospective Chart Review

2019 ◽  
Vol 34 (5) ◽  
pp. 775-782 ◽  
Author(s):  
Stephanie Truong ◽  
Annie Park ◽  
Salem Kamalay ◽  
Nancy Hung ◽  
Jesse G. Meyer ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Parenteral Nutrition ◽  
Insulin Glargine ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Regular Insulin ◽  
Surgical Patients

scholarly journals Glycemic Control in Pediatric Patients on Extracorporeal Membrane Oxygenation

2013 ◽  
Vol 18 (3) ◽  
pp. 227-235
Author(s):  
Kathryn L. Wierer ◽  
Rachel A. Pagryzinski ◽  
Qun Xiang
Keyword(s):  
Glycemic Control ◽  
Extracorporeal Membrane Oxygenation ◽  
Glucose Control ◽  
Chart Review ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Serum Glucose ◽  
Multiple Factors ◽  
Membrane Oxygenation

OBJECTIVES To determine whether glycemic control has an effect on outcomes for pediatric patients on extracorporeal membrane oxygenation (ECMO) therapy, while controlling for multiple factors. METHODS A single-center retrospective chart review was performed on 82 patients who required ECMO from January 1, 2008, to December 31, 2010. All glucose concentrations collected while patients were on ECMO were analyzed; multiple other factors that may have affected mortality were also recorded. Primary outcome was mortality, and secondary outcomes were length of time on ECMO and length of time until death or discharge from the hospital. RESULTS Of 82 patients, 53 patients survived ECMO (64.6%). Glucose control had no effect on survival of patients on ECMO (p=0.56), even when controlling for multiple factors (p=0.48). Similarly, statistical evaluation showed no differences for hospital mortality in relationship to controlled serum glucose (p=0.50). Patients with controlled glucose spent an average of 31.5% more time on ECMO than non-controlled patients (p=0.048). CONCLUSIONS In this study, glycemic control, defined as serum glucose concentration between 60 mg/dL and 250 mg/dL for &gt;95% of the time on ECMO, had no statistically significant effect on mortality for patients on ECMO. Future studies could focus on tighter glucose control or specific dextrose/glucose protocols to evaluate whether improved glucose control would have an effect on morbidity and mortality.

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