Interventions to Improve the Management of Medically Uninsured Adult Patients with Type 2 Diabetes Mellitus in Primary Care, Community-Based Settings

This project measured the effect of a clinical algorithm on the provision of care to medically uninsured adult patients with type 2 diabetes and a low socioeconomic status (SES). Primary providers often fail to implement established standards for diabetes care to their maximal benefit and do not achieve American Diabetes Association (ADA) treatment standards. Saydah, et al. (2004) reported that only 48% of patients with diabetes achieved the recommended HbA1c goal, and 33% reached blood pressure and LDL targets. Goals for all three clinical parameters were obtained by only 7% of patients. The Stetler Model of Evidence-based Practice (EBP) provided the framework for this project. The setting was a primary care clinic for the medically uninsured. Practice patterns for primary care providers were compared to the 2010 ADA standards through chart audits (N = 61). An EBP clinical algorithm was designed and placed within each chart and a focused clinic visit was offered. After three months, a posttest chart audit assessed changes in health care provider practice patterns. Data analysis included descriptive statistics, means, and paired t test describing practice patterns prior to and following implementation of EBP recommendations. All of the 22 process of care standards demonstrated improvement. A pretest audit revealed the mean number of the standards completed was 13.68 (SD = 5.15) and posttest audits identified an increase in the mean number to 18.91 (SD = 4.91). This difference was statistically significant, t(60) = -9.23, (p = .000). The implementation of an evidence-based clinical algorithm to prompt provider interventions resulted in improved care to medically uninsured, adult patients with diabetes