Developing Leadership in Diabetes Care through a Multi-tiered Quality Improvement Model

CONTEXT: We 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. OBJECTIVE: To increase the annual rate of recommended tests and examinations for patients with diabetes and to reduce levels of HgA1c, blood pressure, and LDL cholesterol. INTERVENTION: A process change for type 2 diabetes mellitus was implemented. This included changes in office visit structure; protocol-driven electronic prompts for nursing and physician staffs; clinical decision support built into a new EMR form; and audit with feedback. PARTICIPANTS: 12 primary care physicians treating a total of 1592 patients with diabetes by January, 2008. RESULTS: Prompt and statistically significant improvements in five process measures and 2 outcome measures; 8% overall improvement in a quality summary measure. CONCLUSIONS: Statistically significant improvements with moderate effect size were observed after multi-tiered intervention.Master of Public Healt