Transcript Research Template - UMKC School of Medicine

MAKING THE CHANGE!
An Evaluation of the control of diabetes at the
Sojourner Free Health Clinic
Apurva Bhatt1, Peter Lazarz1, Angela Barnett1,2, Miranda Huffman1,2
1UMKC
School of Medicine, 2Truman Medical Center
Introduction
Results
• The Sojourner Free Health Clinic (SFHC) is a service-based,
student operated clinic located at Grand Avenue United Methodist
Temple in downtown Kansas City, MO.
•25 HbA1C tests were run in 2013, with 15 patients being tested.
• SFHC operates on Sunday afternoons and provides free
outpatient medical services to the homeless and underserved
population of Greater Kansas City.
• In 2012, SFHC opened up a new laboratory which allowed the
clinic to run point of care HbA1C tests free of charge for patients.
This has been an initial step in helping improve the control of
diabetes at the SFHC.
• To date, there have been no studies evaluating the control of type
2 diabetes at SFHC. Quantification of control by measuring
baseline hemoglobin A1C levels in patients with type 2 diabetes is
a necessary first step in the implementation of quality
improvement processes.
• The purpose of this study is to evaluate the control of
hyperglycemia in SFHC’s diabetic patient populations by
measuring A1C values and to propose quality improvement
measures to enhance patient compliance and understanding of
diabetes management.
• Number of patients who met/did not meet ADA goals for
A1C<7%:
Number of patients who met ADA
guidelines of A1C<7%
Number of patients who did NOT
meet ADA guidelines of A1C<7%
6/15
9/15
• These values reflect the most recent A1C value recorded in
our patients.
• 40.0% pf patients tested met goals; 60.0% did not meet
goals.
LIMITATIONS
• 5 of the 15 patients had labs drawn more than once throughout the
year, and their trends are shown below.
• The average A1C of all patients (taking into account only most
recent values for patients tested repeatedly) was 9.08%.
• The average A1C of patients seen regularly for health
maintenance was 8.88%.
• The data showed a 0.20% decrease in A1C levels in patients
treated regularly compared to those treated once. This decrease is
less than optimal and warrants several changes.
• ACCESS: Many patients lack adequate access to medical care
and often visit local emergency departments for care.
• CONTINUITY: Minimal follow-up with patients with uncontrolled
diabetes is due to the transiency of the patient population.
Recommendations
• Retrospective study with small sample size and small number • SFHC should implement quality improvement measures to
of patients who received repeat A1C testing at SFHC, likely
improve diabetes control in its patient population.
due to the transiency of the population seen at the clinic.
• Next steps as indicated by this project include:
• ECONOMIC: Partner with other interprofessional learners to
• We did not evaluate fasting blood sugars, cholesterol or
develop compassionate care programs and with other
blood pressures, all of which are important factors to evaluate
foundations to provide a broader spectrum of medications for
in patients with diabetes. Most patients are not fasting as
improving control of hyperglycemia.
they eat the free lunch provided to them by the church prior to
attending clinic.
• NUTRITION: Provide handouts to patients and partner with
interprofessional learners to provide education.
• This review did not reflect whether the patient was currently
compliant with medication recommendations or if a patient
was currently out of their medications.
Methods
• We did not evaluate patients’ current eating habits or diabetic
education.
• We evaluated HbA1C lab values that were gathered from
SFHC patients from January 2013 to December 2013.
• We did not evaluate patients weight for this study.
• HEALTH EDUCATION and LITERACY: Complete a patient
Health Literacy study to evaluate health literacy in patients at
the clinic. Implement a Patient Discharge Summary Sheet to
enhance patient understanding and compliance to their therapy
regimen.
• ACCESS: Implement a discharge process that includes a
discharge summary sheet, education, and pre-visit planning for
follow-up. Also change lab processes so that patients obtain
labs before eating lunch.
Summary
• We viewed A1C trends from patients who received more than
one A1C test in 2013.
•With this data, we were able to conclude that control of
diabetes at SFHC is suboptimal, with 60.0% of patients not
meeting A1C goals set by the ADA.
• We calculated the average numeric change in A1C by
comparing the first A1C value to the most recent A1C value.
• CONTINUITY: Placement of lab testing reminders in patient
charts to remind SFHC personnel about lab work that needs to
be completed at next visit. Educate patients on proper follow-up
and giving priority for follow-up.
•There are many factors which contribute to poor control of
diabetes in the SFHC patient population:
• We evaluated how well patients met HbA1C goals as specified
by the ADA1.
• We proposed ideas that would help improve control of diabetes
at SFHC.
• HEALTH EDUCATION and LITERACY: Patient health education
and literacy is another factor which affects control of diabetes at
SFHC. Some patients do not understand how to appropriately
take their medications/insulin which affects their control of
diabetes.
• The average change in A1C for patients with repeat values:
0.22% decrease in A1C.
• Patient B showed a 3.2% drop in A1C, from almost 11% to
the desired 7%. This drop is demonstrates the success in
treatment involving intensive patient education on a weekly
basis, lifestyle changes, and medication.
• ECONOMIC: the majority of patients that come to the
clinic are homeless and unemployed. They lack
resources and support towards care.
• NUTRITION: Barriers to adequate nutrition also exist.
• Further Research: Implement measures then perform a follow
up study to evaluate effectiveness of new measures.
References
1.
"Standards of Medical Care in Diabetes-2014." American Diabetes
Association 37.S1 (2014): S14-80. Standards of Medical Care in Diabetes2014. American Diabetes Association. Web. 05 Feb. 2014. Accessed: 01
March 2014.
<http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf+html>.