James Mitchell (Department of Medicine, The George Washington University School of Medicine and Health Sciences), Seemal Awan (Department of Medicine, The George Washington University School of Medicine and Health Sciences), Jeffrey Lankowsky (Department of Medicine, The George Washington University School of Medicine and Health Sciences)
Diabetes Mellitus (DM) is an endemic chronic medical condition that requires a multispecialty approach, which much of the time is led by a primary care provider. Given the ever-increasing workload of physicians, it may not be difficult to overlook certain guidelines when managing patients with diabetes.
The aim of this quality improvement project was to increase diabetes mellitus quality measure reporting by 20% over four months through the initiation of macros.
First, a comprehensive template incorporating standards of quality care as determined by the American Diabetes Association was formulated. Baseline data was then obtained by EMR quarry involving 6 PGY-1 Internal Medicine physicians who agreed to be part of our pilot project. The template was then distributed, and reminders sent to the six residents to encourage template use during their clinic week. During this time, approval was obtained for creation of an enterprise level “macro” consisting of the template that was previously distributed. The 6 PGY-1 physicians’ patient panel were then again quarried for all diabetes quality measures and compared to baseline data.
Our PDSA cycles resulted in an aggregate 14% increase in diabetes quality measurements. Additionally, the physicians involved in the study noted favorite response to the intervention, both feeling it resulted in more efficient appointments and higher quality of care.
The response to the use of macros was positive from the participating residents as they found it helpful in reminding themselves of the guidelines which are occasionally overlooked. The results of the intervention were favorable with 14% increase in quality measure reporting. The next steps in this project are working closely with physicians who oversee the electronic medical records to extend the use of the macro to all physicians in the practice who manage diabetes. Lastly, we hope to streamline the macros in order for the quality measures to automatically be uploaded in order to provide easier documentation.
Implications for Patient Care
This project demonstrates that EMR based “macros” can create substantial opportunity in both increasing patient quality of care and physician adherence to guidelines in a time saving and efficient matter. Exploring further roles of “macros” for guideline driven care has the potential for material impact in healthcare quality.