University Physicians Group is a multi-specialty, 65-physician medical practice with offices in Staten Island and Brooklyn, NY.
The group started their first PDSA cycle to address what they viewed as suboptimal diabetes outcomes during the previous year. They thought communication and educational processes might be improved to help their patients achieve better outcomes.
They began with a simple, pre-visit questionnaire that asked patients what they understood about diabetes and their care plans. This questionnaire covered the purpose of tests for diabetes, what the test results mean, and terminology related to diabetes care. The survey revealed a gap in what the doctors believed their patients understood about their disease and their care plan and what patients actually understood.
The questionnaire results showed that many of the group's diabetic patients did not consistently have the information necessary to properly manage their own care. The survey results also indicated that the patients did not feel comfortable asking questions, even when they did not comprehend the physician's instructions. For example, 21 percent of the patients surveyed did not know the difference between fasting and non-fasting glucose measures, but were afraid to ask their doctor to clarify what the measures meant.
Armed with this information, University Physicians Group developed a plan to accomplish two things:
Improve communication with patients so that they understand their disease and the care plan that they create with their physician
Improve outcomes for patients with diabetes
The plan that University Physicians Group developed relies on the medical assistants (MAs)—who have the most hands-on time with patients—to educate and coach patients with diabetes. The practice disseminated the plan from the executive level to the office managers and MAs. Getting buy-in from the team was easy; diabetes is prevalent among the group's patient population and improving communication is something that interested care team members on both a personal and professional level.
No additional staff needed to be hired; instead, the current MAs were trained to ask patients the following:
Do you have a glucometer? If so, do you know how to properly use it?
Do you know the difference between fasting and non-fasting glucose?
Do you know what HbA1c is and do you know your most recent HbA1c test result?
Do you have insurance? If so, what kind?
Gathering this information helped the MAs tailor the educational material and coaching intensity for each patient. Approximately 150 patients were enrolled in the pilot program across the group's two offices.
After three months of the pilot program, the practice resurveyed patients to check the initial impact. Results were favorable. Data is being collected on an ongoing basis and the group intends to start the “study” step of their PDSA cycle soon. Based on the findings, they will decide if they need to adjust their plan. One aspect of the plan that they already know they'd like to refine during the next PDSA cycle is to use the EHR more effectively for data collection.
The PDSA process was well-received, in part because the initiative selected was equally important to all care team members. University Physician's Group is excited to start on the next cycle.
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