Exploring point-of-care transformation in diabetic care

Exploring point-of-care transformation in diabetic care: A quality improvement approach

Authors: Juneja, Malvika; Mejia de Grubb, Maria C.; Wang, Haijun; Spooner, Kiara; Zoorob, Roger J.

Objective: This quality improvement project evaluated the impact of a point-of-care (POC) HbA1c stat lab intervention and a nurse-assisted expanded visit implemented among patients with uncontrolled type 2 diabetes (T2D) at a community health center in Houston, TX.Methods: This was a before-and-after POC intervention among adult patients who received primary care services between 1 July 2014 and 31 December 2014 (baseline visit) and who had at least one 3-month follow-up visit.

Results: Three hundred eighty-seven patients were included in the study. The majority were <60 years of age (72.1%), female (60.5%), and Hispanic (63%), followed by black (16.5%) and Asian (11.1%). Almost 87% of the patients had uncontrolled T2D (HbA1c >9%) at baseline, with the highest average levels among Hispanic (10.9%) and black (10.7%) patients. There was a significant difference in the HbA1c level before (mean=10.65, SD=1.9291) and after (mean=9.25, SD=1.8187) intervention. The absolute reduction in the level of HbA1c was 1.4% (t=12.834,p<0.001), corresponding to a 13% overall percentage decrease from baseline.

Conclusion: There is a distinct advantage in using a stat HbA1c lab when combined with shared POC visits to assist patients with uncontrolled T2D in lowering the HbA1c, improving self-management, and reducing long-term costs.