Improving compliance with diabetes care using a novel mnemonic: A quality improvement project in an urban primary care clinic.

Abstract

The aim of this quality improvement project was to improve compliance with the delivery of multidimensional patient-centered diabetes care using a streamlined mnemonic based on established diabetes guidelines. Using the Institute for Healthcare Improvement (IHI) model for improvement, four rapid plan-do-study-act cycles primarily implemented different tests of change over eight weeks using a streamlined mnemonic - the LLaVES (lifestyle, laboratory tests, vaccination, examination, social/psychosocial) bundle for screening and case management of patients with diabetes. Secondary to the LLaVES bundle, tests of change were also conducted for clinic team members and patients. Team member engagement utilized a best-practice toolkit for effective communication. Patient engagement implemented validated models to evaluate knowledge of diabetes and stage of change. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. Overall compliance was measured as the diabetes management compliance rate (DMCR), composed of LLaVES implementation, team engagement, and patient engagement scores. The diabetes management compliance rate increased by 72.2%, from a baseline of 49% to 84.4% in eight weeks. Team engagement increased from 76.6% to 92% while patient engagement increased from 70.4% to 87.4%. Diabetes management is complex and requires team and patient engagement to implement a structured and multidimensional process. Composed of established, high-level evidence interventions, the LLaVES bundle is one approach to systematize complex care while taking into account the specific and unique challenges of a health care organization.