Incorporating a Diabetic Flowsheet for Care Tracking

Abstract

Purpose: The purpose of this quality improvement (QI) project was to evaluate the implementation of a comprehensive diabetic care flowsheet within the current Electronic Health Record (EHR) system at Mariposa Community Health Center (MCHC). The goal was to facilitate timely and efficient tracking of evidence-based diabetes care, including assessments,screenings, and referrals. Background: In the U.S., over 38 million people are diagnosed with diabetes; risk factors include age, family history, ethnicity, obesity, physical inactivity, and poor dietary choices. Effective management requires regular monitoring through tests such as fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), and hemoglobin A1C (HbA1c). The American Diabetes Association (ADA) provides guidelines that emphasize lifestyle modifications, regular monitoring, and medical interventions. Health disparities exacerbate diabetes management challenges, especially in underserved communities. In Nogales, Arizona, MCHC faces high diabetes prevalence and resource limitations, highlighting the need for effective management tools. Methods: This QI project involved integrating an electronic diabetic care flowsheet into routine patient care for diabetic patients. A 15-minute presentation was delivered to demonstrate the flowsheet’s use and benefits. The effectiveness of the flowsheet was evaluated through a Qualtrics survey. Results: Nine staff members were invited to participate in the presentation, although only 33% of staff members were signed on, with 11% active participation. An in-person follow-up meeting was conducted with the six staff members of the test pod, achieving 100% attendance at that meeting. The goal of the QI project was to achieve 50% participation in the post-implementation survey of the diabetic flowsheet, although two attempts to complete the survey were recorded, no responses were ultimately submitted. Conclusion: The findings from this QI project underscore the challenges presented with implementing new initiatives at high-volume rural clinics. Moreover, stakeholders' buy-in are paramount in successfully implementing new initiatives. The low survey response suggests a need for enhanced training and ongoing support for staff to facilitate the effective use of the diabetic care flowsheet. Addressing barriers such as high turnover and workload will be essential in future efforts to improve staff engagement and the overall success of quality improvement initiatives.