BACKGROUND: Data have shown that despite the availability of a wide variety of treatment approaches to normalize plasma glucose, the great majority of diabetic patients remain poorly controlled. The goal of a small, rural health care organization that included a critical access hospital and a 25-provider physician group was to improve glycated hemoglobin (A1C) outcomes among patients with Type 2 diabetes and to improve frequency of testing (A1C) levels. IMPLEMENTING THE IMPROVEMENT INITIATIVE: Academic detailing in practice guidelines with algorithms for care and a diabetes self-management education program were the first key activities in the improvement initiative. A variety of performance improvement activities were implemented. A diabetes care flow sheet was used to monitor and report process and outcome measurements. A diabetes registry to enter process and outcome data was introduced; data can be displayed by specific provider, by the organization as a whole, by patients whose A1C is > 7, and by patients who have not had an A1C in the last six months. The diabetes care team includes the patient, the primary care provider who provides medical management, and the diabetes educators (pharmacist and dietitian).RESULTS: As of December 2005, hemoglobin A1C levels averaged 6.7 for the 566 patients in the registry.DISCUSSION: The greatest barrier to implementing the initiative lies in the challenge of trying to provide chronic care in an acute care medical model.
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