Jt Comm J Qual Patient Saf. 2023 Dec;49(12):698-705. doi: 10.1016/j.jcjq.2023.07.009. Epub 2023 Jul 31.
In our suburban primary care clinic, the average rate of screening for diabetes among eligible patients was only 51%, similar to national screening data. We conducted a quality improvement project to increase this rate.
During the 6-month preintervention phase, we collected baseline data on the percentage of eligible patients screened per week (percentage of patients with hemoglobin A1c checked in the prior 3 years out of patients eligible for screening who completed a visit during the week). We then implemented a two-phase intervention. In phase 1 (approximately 8 months), we generated an electronic health record (EHR) report to identify eligible patients and pended laboratory orders for physicians to sign. In phase 2 (approximately 3 months), we replaced the phase 1 intervention with an EHR clinical decision support tool that automatically identifies eligible patients. We compared screening rates in the preintervention vs. intervention period. For phase 1, we also assessed laboratory completion rates and the laboratory results. We surveyed physicians regarding intervention acceptability and satisfaction at 3, 6, 9, and 12 months during the intervention period.
The weekly percentage of patients screened increased from an average of 51% in the preintervention phase to 65% in the intervention phase (p < 0.001). During phase 1, most patients underwent laboratory blood testing as recommended (83% within 3 months), and results were consistent with prediabetes in 23% and with diabetes in 4%. Overall, most physicians believed that the intervention appropriately identified patients due for screening and was helpful (100% of respondents agreed at 9 months vs. 71% at 3 months).
We successfully implemented a systematic screening intervention involving a manual workflow and EHR tool and improved diabetes screening rates in our clinic.
在我们的郊区基层医疗诊所，符合条件的患者糖尿病筛查率仅为 51%，与全国筛查数据相似。我们开展了一项质量改进项目，以提高这一比例。
在 6 个月的干预前阶段，我们收集了每周筛查合格患者比例的基线数据（在过去 3 年内完成就诊且当周就诊的患者中，血红蛋白 A1c 检查的患者比例，除以有资格接受筛查的患者比例）。然后，我们实施了两阶段干预。在第一阶段（大约 8 个月），我们生成了一份电子健康记录（EHR）报告，以识别合格患者，并为医生挂起实验室订单以供签字。在第二阶段（大约 3 个月），我们用 EHR 临床决策支持工具取代了第一阶段干预，该工具可以自动识别合格患者。我们比较了干预前和干预期间的筛查率。对于第一阶段，我们还评估了实验室完成率和实验室结果。在干预期间的 3、6、9 和 12 个月，我们调查了医生对干预的接受程度和满意度。
每周筛查患者的比例从干预前阶段的平均 51%增加到干预阶段的 65%（p < 0.001）。在第一阶段，大多数患者按照建议进行了实验室血液检测（3 个月内 83%），结果显示 23%处于糖尿病前期，4%患有糖尿病。总的来说，大多数医生认为干预适当地识别了需要进行筛查的患者，并且对他们有帮助（9 个月时 100%的受访者同意，而 3 个月时为 71%）。
我们成功地实施了一项系统性的筛查干预措施，涉及手动工作流程和 EHR 工具，并提高了我们诊所的糖尿病筛查率。
