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 Risk of Complications with the Total Contact Cast in Diabetic Foot Disorders

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Alexandria Riopelle ◽  
Ryan LeDuc ◽  
Michael S. Pinzur ◽  
Adam P. Schiff
Keyword(s):  
Diabetic Foot ◽  
Chart Review ◽  
Hemoglobin A1c ◽  
Treatment Algorithm ◽  
Retrospective Chart Review ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Charcot Foot ◽  
Total Contact Cast ◽  
Definition Of

Category: Diabetes Introduction/Purpose: The total contact cast is an important component of the clinical treatment algorithm for diabetic foot ulcers and Charcot Foot Arthropathy. Few studies have reported on the complications associated with this treatment modality. Methods: Over a ten year period, 2265 total contact casts were placed on 384 patients during their treatment for diabetic foot disorders. All of the casts were applied by a Certified Orthopaedic Technologist under the supervision of a University Faculty member. Complications were grouped as: (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change / removal. Complications were then associated with Hemoglobin A1C levels at the time of treatment. Results: Using this very stringent definition of a complication, ten percent of patients had some form of a complication. Most complications resolved following cast change or cast removal. Conclusion: The total contact cast has been demonstrated to be a valuable tool in the treatment of diabetic foot disorders. This retrospective chart review should serve as a valuable reference to assist clinicians when counseling patients during treatment for diabetic foot disorders.

PARTIAL HOSPITALIZATION: AN INTERVENTION FOR YOUTH WITH POORLY CONTROLLED DIABETES MELLITUS

2019 ◽  
Vol 25 (10) ◽  
pp. 1041-1048
Author(s):  
Serife Uysal ◽  
Jose Bernardo Quintos ◽  
Diane DerMarderosian ◽  
Heather A. Chapman ◽  
Steven E. Reinert ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Diabetic Ketoacidosis ◽  
Hemoglobin A1c ◽  
Laboratory Data ◽  
Retrospective Chart Review ◽  
Clinic Visit ◽  
Partial Hospitalization ◽  
Partial Hospitalization Program ◽  
The Mean

Objective: To examine the efficacy of an integrated medical/psychiatric partial hospitalization program (PHP) to improve glycemic control in youth with both diabetes mellitus and mental health disorders. Methods: This retrospective chart review is of patients admitted to a PHP between 2005–2015 with concerns about diabetes mellitus care. Clinical characteristics, laboratory data, diabetic ketoacidosis hospitalizations, and outpatient clinic visit frequency were collected from the year prior to the year after PHP admission. Results: A total of 43 individuals met inclusion criteria: 22 (51%) were female, 40 (93%) had type 1 diabetes, the mean age was 15.2 ± 2.3 years, and the mean diabetes mellitus duration was 4.6 ± 3.6 years. Of those individuals, 35 of these patients had hemoglobin A1c (HbA1c) data available at baseline, 6 months, and 1 year after PHP. The average HbA1c before PHP admission was 11.3 ± 2.3% (100.5 ± 25 mmol/mol), and decreased to 9.2 ± 1.3% (76.7 ± 14.8 mmol/mol) within 6 months of PHP admission ( P<.001). The average HbA1c 1 year after PHP was 10.7 ± 1.7 % (93.3 ± 19.1 mmol/mol). Overall, 24 patients (68%) had lower HbA1c, and 75% of those with improvement maintained an HbA1c reduction of ≥1% (≥10 mmol/mol) at 1 year compared to before PHP. Conclusion: Most patients demonstrated improved glycemic control within 6 months of PHP admission, and many of those maintained a ≥1% (≥10 mmol/mol) reduction in HbA1c at 1 year following PHP admission. This program may represent a promising intervention that could serve as a model for intensive outpatient management of youth with poorly controlled diabetes mellitus. Abbreviations: ADA = American Diabetes Association; DKA = diabetic ketoacidosis; EMR = electronic medical record; HbA1c = hemoglobin A1c; ICD-9 = International Classification of Diseases, 9th revision; PHP = partial hospitalization program

scholarly journals Secondary prevention among uninsured stroke patients: A free clinic study

2020 ◽  
Vol 8 ◽  
pp. 205031212096532
Author(s):  
Madeline R MacDonald ◽  
Sydney Zarriello ◽  
Justin Swanson ◽  
Noura Ayoubi ◽  
Rahul Mhaskar ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Medical Records ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Free Clinics ◽  
Stroke Patients ◽  
Uninsured Patients ◽  
Patients With Diabetes ◽  
History Of ◽  
Clinic Study

Objectives: Free clinics manage a diversity of diseases among the uninsured. We sought to assess the medical management of stroke in a population of uninsured patients. Methods: A retrospective chart review was conducted to collect chronic disease statistics from 6558 electronic medical records and paper charts at nine free clinics in Tampa, Florida, from January 2016 to December 2017. Demographics and risk factors were compared between stroke patients and non-stroke patients. Medication rates for several comorbidities were also assessed. Results: Two percent (107) of patients had been diagnosed with a stroke. Stroke patients were older (mean (M) = 56.0, standard deviation (SD) = 11.2) than the rest of the sample (M = 43.3, SD = 15.4), p < 0.001 and a majority were men (n = 62, 58%). Of the stroke patients with hypertension (n = 79), 81% (n = 64) were receiving anti-hypertensive medications. Of the stroke patients with diabetes (n = 43), 72% (n = 31) were receiving diabetes medications. Among all stroke patients, 44% were receiving aspirin therapy (n = 47). Similarly, 39% of all stroke patients (n = 42) were taking statins. Conclusions: Uninsured patients with a history of stroke may not be receiving adequate secondary prevention highlighting the risk and vulnerability of uninsured patients. This finding identifies an area for improvement in secondary stroke prevention in free clinics.

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

Cost Comparison of Treating Uninsured Patients at a Hospital-Based Free Clinic, Emergency Room, and Inpatient Hospitalizations: A Retrospective Chart Review

2013 ◽  
Vol 6 (1) ◽  
pp. 47-52
Author(s):  
Michelle Walker
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Free Clinic ◽  
Inpatient Hospitalization ◽  
Care Services ◽  
Preventative Health ◽  
Inpatient Hospitalizations ◽  
Preventative Health Care

Purpose: The rates of the uncompensated health care services have steadily increased across the nation since 2008. Uninsured individuals are less likely to receive preventative services and are more likely to suffer adverse health outcomes and hospitalization for acute conditions. Providing primary and preventative health care to the uninsured is potentially more cost-effective through free clinics as compared to emergency room (ER) or inpatient care. A retrospective chart review was conducted to compare the cost of treating patients in a free clinic, ER, and inpatient hospitalization at one regional hospital in Pennsylvania. Methods: A descriptive, correlational study was conducted in a rural free clinic and its affiliate hospital in Altoona, Pennsylvania. Patients were selected to participate if they were active patients during the fiscal years of the study. A convenience sample (n = 242) of active clinic patients during the fiscal years of the study was selected for chart review. Consent was obtained to access their records. Medical charts were reviewed for frequency of visits, diagnoses, time, charges of ER, and inpatient hospitalizations for the fiscal years of 2009 and 2010. Direct costs for the free clinic were obtained from the executive director. ER and inpatient hospitalization charges were obtained from the regional hospital chief financial officer. Results/Analysis: The data indicate a decrease in average patient clinic visit cost from 2009 to 2010 from $84 to $74. There was a 54% increase in patient visits within that time frame, with patient comorbidities increasing from 1 in 2009 to 4 in 2010. There was found to be a significant positive correlation between clinic visits, inpatient hospitalizations and ER visits in 2009 and a weaker correlation in 2010. Patients were seen in the clinic 23 times their inpatient visits and 45 times their ER visits in 2010. Conclusion: Implications for practice suggest these clinics can provide primary health care needs to patients without insurance in declining health for a reasonable cost. Overall preventative health care services will decrease ER and inpatient hospitalizations and ultimately health care costs.

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