Purpose – The purpose of this paper is to pilot‐test the feasibility and impact of protocol‐driven point‐of‐care HbA1c testing on levels of glycemic control and on rates of diabetic regimen intensification in an urban community health center serving low‐income patients. Design/methodology/approach – The paper suggests a primary care process re‐design, using point of care finger‐stick HbA1c testing under a standing order protocol that provided test results to the provider at patient visit. Findings – The paper finds that the protocol was well received by both nurses and physicians. HbA1c testing rates increased from 73.6 percent to 86.8 percent ( p =0.40, n =106). For the 69 patients who had both pre‐ and post‐intervention results, HbA1c levels decreased significantly from 8.55 to 7.84 ( p =0.004, n =69). At baseline, the health center as a system was relatively ineffective in responding to elevated HbA1c levels. An opportunity to intensify, i.e. a face‐to‐face visit with lab results available, occurred for only 68.6 percent of elevated HbA1c levels before the intervention, vs. 100 percent post‐intervention ( p <0.001). Only 28.6 percent of patients with HbA1c levels >8.0 had their regimens intensified in the pre‐intervention phase, compared with 53.8 percent in the post‐intervention phase ( p =0.03). Research limitations/implications – This was a pilot‐study in one urban health center. Larger group‐randomized controlled trials are needed. Practical implications – The health center's performance as a system, improved significantly as a way of intensifying diabetic regimens thereby achieving improved glycemic control. Originality/value – This intervention is feasible, replicable and scalable and does not rely on changing physician behaviors to improve primary care diabetic outcomes.
International Journal of Health Care Quality Assurance – Emerald Publishing
Published: May 2, 2008
Keywords: Diabetes; Primary care; Quality improvement; Redesign
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.
All for just $49/month
Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly
Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.
Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.
Read from thousands of the leading scholarly journals from SpringerNature, Wiley-Blackwell, Oxford University Press and more.
All the latest content is available, no embargo periods.
“Hi guys, I cannot tell you how much I love this resource. Incredible. I really believe you've hit the nail on the head with this site in regards to solving the research-purchase issue.”Daniel C.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud
“I must say, @deepdyve is a fabulous solution to the independent researcher's problem of #access to #information.”@deepthiw
“My last article couldn't be possible without the platform @deepdyve that makes journal papers cheaper.”@JoseServera