International Journal for Quality in Health Care Advance Access originally published online on December 24, 2008
International Journal for Quality in Health Care 2009 21(2):130-136; doi:10.1093/intqhc/mzn060
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A patient outreach program between visits improves diabetes care: a pilot study
1 Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, USA
2 Department of Family Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, USA
Objective. Barriers to guideline-based diabetes care include poor patient activation, haphazard clinic appointments, poorly organized medical records and a lack of automated physician decision support. We developed a patient recall intervention to mitigate these barriers and improve diabetes care coordination. We evaluated this intervention in terms of operational feasibility, provider and patient acceptance and effects on process of care measures.
Methods. On the basis of the American Diabetes Association criteria, we identified patients with diabetes in a large internal medicine practice who were due for provider visits; hemoglobin A1c, lipid, microalbumin and serum creatinine laboratories; and retinal examinations. An outreach coordinator contacted patients to summarize this information and schedule recommended services. We assessed patient responsiveness to outreach and used medical chart review to compare diabetes care rendered before and after the intervention. Providers gave feedback about their satisfaction with the program.
Results. Over 3 months, 709 patients were overdue for diabetes-related services. Of 415 overdue for provider visits, a total of 125 (30.1%) completed such visits arranged by an outreach coordinator and, of these, 101 (80.8%) completed laboratories at least a day ahead of time. An additional 52 out of 415 patients (12.5%) bypassed the outreach coordinator to self-schedule diabetes visits within a 6-week period after the outreach letter was mailed. Among overdue patients, completion of recommended services and intensity of diabetes care were significantly greater through the outreach program compared with traditional care. Provider attitudes were favorable.
Conclusions. An outreach intervention was associated with improved timeliness and intensity of diabetes care in an outpatient setting. The success of this pilot program in terms of process measures warrants additional evaluation focused on clinical outcomes.
Keywords: quality improvement, quality management, quality indicators, measurement of quality, guidelines, appropriate health care, endocrine disorders, incl. diabetes, disease categories, primary care, general practice, setting of care, general medicine, professions, information technology, professions
Address reprint requests to: Thomas D. Denberg, Division of General Internal Medicine, B180, Academic Office Building (AO1), 12631 East 17th Avenue, PO Box 6511, Aurora, CO 80045, USA. Tel: +1-303-724-2265; Fax: +1-303-724-2270; E-mail: tom.denberg{at}ucdenver.edu
Accepted for publication October 31, 2008.