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American Journal of Medical Quality
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Improving Diabetes Care Using a Multitiered Quality Improvement Model

John Guzek, MD, MPH

Commonwealth Medical College, Scranton, Pennsylvania, and the University of North Carolina-Chapel Hill, guzekjr{at}gmail.com

Suzanne Guzek, MS, CRC

Walden University, Baltimore, Maryland

Karen Murphy, PhD

Section of Informatics and Administration, Physicians Health Alliance, Scranton, Pennsylvania

Patricia Gallacher, BS

Section of Informatics and Administration, Physicians Health Alliance, Scranton, Pennsylvania

Cheryll Lesneski

University of North Carolina-Chapel Hill

The authors report the results of implementing a diabetes mellitus guideline in a group practice in which uniform, technology-generated care processes were produced for patients, clinical staff, and providers. The objective was to increase the annual rate of recommended tests and examinations for patients with diabetes and to reduce levels of glycosylated hemoglobin, blood pressure, and low-density lipoprotein cholesterol. A process change for type 2 diabetes mellitus was implemented that included changes in office visit structure, protocol-driven electronic prompts for nursing and physician staffs, clinical decision support built into a new electronic medical record form, and audit with feedback. Twelve primary care physicians treated a total of 1592 patients with diabetes between January 2007 and January 2008. There were prompt and statistically significant improvements in 5 process measures and 2 outcome measures; a quality summary measure showed 8% overall improvement. Statistically significant improvements with moderate effect size were observed after a multitiered intervention. (Am J Med Qual 2009;24:505-511)

Key Words: diabetes • quality improvement • electronic medical record • clinical decision support

This version was published on November 1, 2009

American Journal of Medical Quality, Vol. 24, No. 6, 505-511 (2009)
DOI: 10.1177/1062860609346348
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