(P112) Insights from a Quality Improvement Initiative in Type 2 Diabetes Utilizing Surveys and Chart Reviews

Key Takeaways of Your Research: 1. Delay in both treatment intensification in patients with unmanaged type 2 diabetes (T2D) and in the implementation of effective weight loss strategies results in patients struggling to reach their recommended A1C and weight loss goals. 2. As the root causes for sub-optimal outcomes in T2D are complex, quality improvement (QI) initiatives are critical tools for understanding and addressing system-specific barriers to care for patients with T2D. 3. Baseline data collected as part of the QI initiative in 2 large community health systems revealed challenges and barriers to guideline-based management of T2D, including appropriate weight management. The data also point to variations in diabetes care provider perceptions and attitudes, and patient outcomes measures between the two health systems.

Background/Purpose: Timely and sustained glycemic management and weight loss are critical to reducing the risks of long-term health problems associated with T2D. Despite clinical practice guidelines recommending prompt escalation of antidiabetic therapies to reach glycemic targets, treatment intensification in patients with unmanaged T2D and effective weight loss strategies are often delayed. QI initiatives can help identify and address system-level gaps in care in T2D. Research Hypothesis and/or Research Questions and Specific

Aims: By addressing system-specific gaps in care we will achieve timely management of A1C and body weight among patients with T2D. The specific aims are to (1) identify clinical barriers to care for patients with T2D; (2) address gaps in care through focused patient and provider education. Methods/Methodology: This ongoing multi-component QI initiative includes diabetes care provider baseline and follow-up surveys and audits of electronic medical records (EMRs) of patients with T2D sampled based on predetermined inclusion criteria. The baseline survey and EMR audit findings are reviewed in the team-based audit-feedback sessions and patient-provider collaborative education sessions at the participating health systems.

Results: Two large community health systems in North Carolina and West Virginia are enrolled. Providers (n = 68) expressed greater satisfaction with the processes implemented in their health system for glycemic management than for weight management. Although a similar number of providers reported assessing A1C and BMI frequently, a greater proportion of providers reported discussing A1C goals with their patients compared to weight-loss goals. The findings from the EMR audit (n = 50 from each system) varied between the two health systems regarding diabetes treatment, patient education, and shared-decision making. Full results from the baseline EMR audit and diabetes provider surveys, and outcomes from the two audit-feedback sessions will be presented. Conclusions (Impact on Diabetes Care and Education): Factors contributing to sub-optimal treatment outcomes in T2D are complex. QI initiatives are critical tools for understanding and addressing system-specific barriers to care for patients with T2D. Our provider surveys and EMR audit reveal challenges and gaps in practice patterns related to glycemic management and weight loss for patients with T2D. These care gaps may be closed through focused education targeting patients and providers. Source of Funding for this Research: The study reported in this abstract was funded by an independent educational grant from Eli Lilly and Company, which had no role in the study design, execution, analysis, or reporting. Authors: Juan Pablo Frias, MD. Medical Director and Principal Investigator, Velocity Clinical Research, Los Angeles, CA, Anne L Peters, MD. Professor of Clinical Medicine, Director of the Clinical Diabetes Program, Keck School of Medicine of USC, Los Angeles, CA, Jeffrey D Carter, PhD. Vice President, Research, PRIME Education, LLC, Fort Lauderdale, FL, Thushara Chakkath, PhD. Associate Director, Scientific Affairs, PRIME Education, LLC, Fort Lauderdale, FL, Cherilyn Heggen, PhD. Vice President, Scientific Affairs, PRIME Education, LLC, Fort Lauderdale, FL.