A1c Point of Care Testing with Type II Diabetes Patients to Increase Patient Engagement and Improve Glycemic Control

Abstract

Background: Diabetes is at the forefront of chronic disease management. As the 7th leading cause of death in the United States, 34.2 million Americans are diagnosed with diabetes, and 95% have type 2 diabetes. Uncontrolled diabetes can result in long-term complications, increased hospitalizations, and premature deaths. Patient and provider partnerships are essential to increasing patient engagement to improve health care outcomes. Patient engagement, inclusive of collaboration with healthcare providers, promotes shared decision-making, enhancing patient self-care behaviors and effective disease self-management. Evidence supports that implementing point-of-care A1c testing (POCT HbA1c) in primary care settings promotes patient engagement with diabetes self-management resulting in improved patient glycemic control and attainment of organizational benchmarks for diabetic Value-Based Care quality metrics. Purpose: The purpose of this quality improvement project was for uncontrolled (HbA1c>8%) Type II diabetes patients to use POCT HbA1c to improve their glycemic control. Methods: Bandura’s Self-Efficacy Theory provided the theoretical framework. The RE-AIM model with PDSA cycles guided the project implementation. Data analysis consisted of descriptive and inferential analyses to track the implementation effectiveness of POCT HbA1c to improve glycemic control. Results: Data tracking demonstrated that implementation of POCT HbA1c increased diabetes patient self-management and improved glycemic control as evidenced by decreased HbA1c and FBS results. SES scores did not demonstrate statistical significance but there was clinical significance with increased patient engagement. Conclusions/Implications for Practice: The project outcomes supported that uncontrolled Type II diabetes patients who engage in the use of POCT HbA1c increase self-management resulting in improved glycemic control. Health care providers managing uncontrolled Type II diabetes patients should strongly consider using POCT HbA1c for diabetes patient self-management. Positive financial outcomes for both the patient and healthcare system can be a benefit with the use of POCT HbA1c. Project alignment with organizational initiatives is essential for obtaining support for implementation changes and long-term sustainability by conducting subsequent PDSA cycles.