Date on Paper
8-2023
Document Type
Doctoral Paper
Degree Name
D.N.P.
Department
Nursing
Committee Chair
Volpert, Elisabeth
Committee Member
Hall, Lynne
Author's Keywords
prediabetes; primary care; education; diabetes prevention
Abstract
Improving Prediabetes Screening, Diagnosis, and Referral to a Diabetes Prevention Program in the Primary Care Setting
Table of Contents
Abstract……………………………………………………………………………………………4
Background………………………………………………………………………………………..5
Purpose…………………………………………………………………………………………...10
Literature Review……………………………………………………………………………...…10
Conceptual Framework…………………………………………………………………………..15
Setting………………………………………………………………………………………...….17
Context…………………………………………………………………………………………..18
Procedures/Intervention…….……………………………………………………………………19
Ethical Considerations…..……………………………………………………………………….20
Measures…………………………………………………………………………………………20
Data Analysis……………………………………………...……………………………………..22
Results……………………………………………………………………………………………23
Discussion……………………………………………………………………………...………...26
References……………………………………………………………………………………….33
Appendix A: Implementation Timeline…………………………………………………………40
Appendix B: IROC Quality Improvement Leadership Approval Letter………………………...41
Appendix C: PCP Referral Process and Diabetes Prevention Program Referral Order………...42
Figure 1: Monthly Number of N-DPP EHR Referrals by PCPs…………………………………….43
Figure 2: Monthly Total PCP Screening HbA1c/FBG Orders vs. Monthly Results HbA1cs……44
Figure 3: Demographic Analysis: Patients with a Documented Prediabetes ICD-10 (R73.03/R73.0)………………………………………………………………………………………….45
Abstract
Background: Prediabetes is a term used to identify an abnormal metabolic state of impaired glucose regulation and blood glucose levels above normal range, but not high enough to meet the criteria for Type 2 Diabetes Mellitus (T2DM) (American Diabetes Association [ADA], 2019). According to the ADA (2019), the progression of prediabetes to T2DM can take anywhere from five to ten years, which leaves a window to refer individuals to evidence-based lifestyle change programs, such as the National Diabetes Prevention Program (N-DPP).
Purpose: The purposes of this project were to increase electronic health record referrals to the organization’s diabetes educator, N-DPP, and optimize early identification and treatment of prediabetes in asymptomatic, non-pregnant adults ages 18-89 years old via primary care provider (PCP) education.
Setting: This project occurred at an Internal Medicine clinic in downtown Louisville, KY.
Methods/Procedures: An educational session for PCPs in the clinic occurred during a monthly staff meeting on February 9, 2023. The session involved a 15-minute PowerPoint presentation which outlined the national and state prevalence of prediabetes, described patient’s risk factors for developing prediabetes, the efficacy for screening and referral for prediabetes, and provided standardized instructions on how to refer prediabetic patients to the department’s N-DPP through the clinic’s EHR (Epic).
Measures: Outcomes measures included the total number of patients with a diagnosis of prediabetes in the problem list, total number of prediabetes screening HbA1c orders for prediabetic patients, the number of patients referred to the diabetes educator by EHR, and the total number of patients with a documented HbA1c of 5.7%-6.4%.
Results: Two retrospective queries were made to the clinical site’s EHR (Epic™) and revealed 190 patients presented to the clinic between December 8, 2022, through February 8, 2023, and 295 patients visited the clinic from February 9, 2023-May 9, 2023, with a documented prediabetes diagnosis or elevated blood glucose (ICD-10 R73.03 or R73.0) in the problem list. The results of descriptive analysis were categorized in Figure 3; 35% (n = 102) of the 295 patients in the post-implementation phase with R73.03 or R73.0 in the problem list were identified as newly diagnosed with prediabetes. Prior to PCP education, PCPs placed orders for 245 HbA1c prediabetes screenings compared to 428 prediabetes HbA1cs screenings in the post-implementation phase. Initially, PCPs placed zero EHR referrals to the N-DPP, but after education 15 EHR referrals were initiated to the N-DPP. A standardized N-DPP EHR referral process was established.
Conclusion: More efforts are needed to improve PCP prediabetes screening, diagnosis, and referral to diabetes prevention programs.
Recommended Citation
Morguelan, Brittany, "Improving prediabetes screening, diagnosis, and referral to a diabetes prevention program in the primary care setting." (2023). Doctor of Nursing Practice Papers. Paper 134.
Retrieved from https://ir.library.louisville.edu/dnp/134
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