Abstract：
BACKGROUND: A multidisciplinary, multifaceted approach to disease management that incorporates the health system, the provider, and the patient is supported in the literature. There was a need to improve patient outcomes to meet or to exceed the Health Plan Employer Data and Information Set (HEDIS) benchmarks for the management of patients with diabetes.
OBJECTIVE: The purpose of this study was to implement a process improvement effort using practice guidelines on the basis of an evidence-based practice model for the management of type II diabetes mellitus at two primary care clinics at two military medical facilities in Hawaii.
METHODS: A retrospective review of charts, electronic records, and system data revealed that the clinics used as project sites were not compliant with established guidelines for diabetes management. After a literature review and an analysis of the current processes, a multidisciplinary care delivery model was developed and implemented to identify spheres of influence involving all members of the diabetes management team and the tasks that influenced patient outcomes.
RESULTS: Improvements were seen for more than 6 months of initial practice change, including compliance with annual glycosylated hemoglobin (HbA1c), lipid, blood pressure, and foot checks. At Site 1, HEDIS measures increased for adequately controlled HbA1c and low-density lipoprotein (LDL) from 80% to 85% and from 49% to 58%, respectively. Site 2 showed an increase in adequate control of HbA1c from 77% to 79% at 6 months. After a steady increase in compliance, the percentage for adequately controlled LDL dropped to 56% at 9 months. At Site 1, HEDIS measures decreased slightly to 82% for HbA1c control and to 54% for LDL control at the 9-month mark.
CONCLUSIONS: Inconsistent delivery of care and lack of staff and patient involvement influenced process outcomes. There were challenges with database accuracy, adequate staffing, computer software upgrades, and overseas site locations. Annual foot examinations showed the largest improvement over time. Site 1 had a significant increase in filament testing because of an innovative strategy to develop a competency program to educate technicians to perform the assessment during the patient check-in process. Sustainability is needed to improve overall patient quality and patient safety and to decrease variation in care among medical treatment facilities over time.
OBJECTIVE: The purpose of this study was to implement a process improvement effort using practice guidelines on the basis of an evidence-based practice model for the management of type II diabetes mellitus at two primary care clinics at two military medical facilities in Hawaii.
METHODS: A retrospective review of charts, electronic records, and system data revealed that the clinics used as project sites were not compliant with established guidelines for diabetes management. After a literature review and an analysis of the current processes, a multidisciplinary care delivery model was developed and implemented to identify spheres of influence involving all members of the diabetes management team and the tasks that influenced patient outcomes.
RESULTS: Improvements were seen for more than 6 months of initial practice change, including compliance with annual glycosylated hemoglobin (HbA1c), lipid, blood pressure, and foot checks. At Site 1, HEDIS measures increased for adequately controlled HbA1c and low-density lipoprotein (LDL) from 80% to 85% and from 49% to 58%, respectively. Site 2 showed an increase in adequate control of HbA1c from 77% to 79% at 6 months. After a steady increase in compliance, the percentage for adequately controlled LDL dropped to 56% at 9 months. At Site 1, HEDIS measures decreased slightly to 82% for HbA1c control and to 54% for LDL control at the 9-month mark.
CONCLUSIONS: Inconsistent delivery of care and lack of staff and patient involvement influenced process outcomes. There were challenges with database accuracy, adequate staffing, computer software upgrades, and overseas site locations. Annual foot examinations showed the largest improvement over time. Site 1 had a significant increase in filament testing because of an innovative strategy to develop a competency program to educate technicians to perform the assessment during the patient check-in process. Sustainability is needed to improve overall patient quality and patient safety and to decrease variation in care among medical treatment facilities over time.
摘要：
背景：多学科，纳入卫生系统的疾病管理的多方面方法，提供者,患者在文献中得到支持。有必要改善患者的预后，以达到或超过健康计划雇主数据和信息集（HEDIS）的糖尿病患者管理基准。
目的：本研究的目的是在基于循证实践模型的基础上，在夏威夷两个军事医疗机构的两个初级保健诊所中，使用实践指南实施过程改进工作。
方法：对图表的回顾性回顾，电子记录,和系统数据显示，用作项目地点的诊所不符合既定的糖尿病管理指南。经过文献回顾和对当前流程的分析，我们开发并实施了多学科护理模式,以确定涉及糖尿病管理团队所有成员的影响范围和影响患者结局的任务.
结果：在6个月以上的初始实践变化中，出现了改进，包括符合年度糖化血红蛋白（HbA1c），脂质，血压,和脚检查。在站点1，HbA1c和低密度脂蛋白（LDL）充分控制的HEDIS措施从80％增加到85％，从49％增加到58％，分别。站点2显示在6个月时HbA1c的充分控制从77%增加到79%。在合规稳步提高之后，LDL得到充分控制的百分比在9个月时下降到56%.在站点1，HbA1c控制的HEDIS措施在9个月时略微下降至82％，LDL控制的HEDIS措施下降至54％。
结论：护理提供不一致以及缺乏工作人员和患者参与影响了治疗结果。数据库准确性面临挑战，足够的人员配备，计算机软件升级，和海外网站位置。随着时间的推移，年度足部检查显示出最大的改善。站点1的灯丝测试显着增加，因为采用了创新策略来开发能力计划，以教育技术人员在患者入住过程中进行评估。需要可持续性来提高整体患者质量和患者安全，并随着时间的推移减少医疗设施之间的护理差异。
目的：本研究的目的是在基于循证实践模型的基础上，在夏威夷两个军事医疗机构的两个初级保健诊所中，使用实践指南实施过程改进工作。
方法：对图表的回顾性回顾，电子记录,和系统数据显示，用作项目地点的诊所不符合既定的糖尿病管理指南。经过文献回顾和对当前流程的分析，我们开发并实施了多学科护理模式,以确定涉及糖尿病管理团队所有成员的影响范围和影响患者结局的任务.
结果：在6个月以上的初始实践变化中，出现了改进，包括符合年度糖化血红蛋白（HbA1c），脂质，血压,和脚检查。在站点1，HbA1c和低密度脂蛋白（LDL）充分控制的HEDIS措施从80％增加到85％，从49％增加到58％，分别。站点2显示在6个月时HbA1c的充分控制从77%增加到79%。在合规稳步提高之后，LDL得到充分控制的百分比在9个月时下降到56%.在站点1，HbA1c控制的HEDIS措施在9个月时略微下降至82％，LDL控制的HEDIS措施下降至54％。
结论：护理提供不一致以及缺乏工作人员和患者参与影响了治疗结果。数据库准确性面临挑战，足够的人员配备，计算机软件升级，和海外网站位置。随着时间的推移，年度足部检查显示出最大的改善。站点1的灯丝测试显着增加，因为采用了创新策略来开发能力计划，以教育技术人员在患者入住过程中进行评估。需要可持续性来提高整体患者质量和患者安全，并随着时间的推移减少医疗设施之间的护理差异。
