Implementing a Self-Management Glucose Monitoring Pathway to Improve Glycemic Control

Introduction: Nationwide and locally in Los Angeles, CA, uncontrolled diabetes remains a complex chronic condition within the primary care setting. Chronically uncontrolled diabetes is costly for patients and health care systems due to high morbidity and mortality rates. As payor sources move in the direction of providing payment based on core measures and value-based care, chronic illness programs designed to improve these outcomes must be developed, implemented, and sustained. The Federally Qualified Health Center (FQHC) in which this quality improvement project was conducted represents the largest of 11 comprehensive care, family practice FQHCs in the South-Central Los Angeles area. Background: A systematic review of available literature was performed. Patient self-monitoring of blood glucose (SMBG) levels emerged as an evidence-based and reliable patient-driven intervention promoting improved diabetic care. Aims and Objectives: The quality improvement project aims are centered around the improvement of diabetic patient’s self-care behaviors, specifically to improve glycemic control for uncontrolled diabetic outpatients by implementing a SMBG clinical pathway. Methods: One primary care provider team within the FQHC implemented a pilot program utilizing daily patient-driven self-monitoring of blood glucose levels. The pilot team used a SMBG clinical pathway to guide clinical decision-making for diabetic patients seen within the provider panel. Patients with an A1c ≥ 10% were offered participation in daily SMBG. The intervention was implemented over a 6-month period of time and evaluated pre and post-intervention A1c measurement and patient/staff satisfaction surveys. Results: Eighteen patients participated, 72% (n=13) of the participants kept glucose logs and attended the monthly follow-up visits. Of these, 54% (n=7) reduced their A1c by ≥ 2% and 69% (n=9) had at least some reduction in A1c. Patients reported improved self-management knowledge and staff reported satisfaction with the pathway. Discussion: The use of SMBG improved A1c and self-management for those patients who continued follow-up, and staff endorsed the value added from the SMBG pathway which portends well for scaling up the intervention in the setting. Scaling up the SMBG pathway throughout the 11 clinical locations in the FQHC would benefit diabetic patients whose glucose is uncontrolled