Authors' Affiliations

Rebecca T. Clark, College of Nursing, East Tennessee State University, Johnson City, TN. Christine M. Mullins, College of Nursing, East Tennessee State University, Johnson City, TN. Jean C. Hemphill, College of Nursing, East Tennessee State University, Johnson City, TN.

Faculty Sponsor’s Department

Nursing

Name of Project's Faculty Sponsor

Dr. Christine Mullins

Additional Sponsors

Dr. Jean Croce Hemphill

Type

Poster: Competitive

Classification of First Author

Graduate Student-Doctoral

Project's Category

Family Health Services, Rural Health

Abstract Text

Introduction: Prediabetes is major risk factor for the development of Type 2 Diabetes Mellitus (T2DM). One-third of the population in the United States has prediabetes, but 90% remain undiagnosed because healthcare providers are not performing screenings, making this a public health challenge. The purpose of this process improvement project was to implement prediabetes screening, prediabetes identification, and a referral process to a nutritionist to prevent or delay the onset of T2DM in patients in two Federally Qualified Health Centers. Methods: This was a quality improvement project conducted over a six-week period after receiving exemption from the University’s Internal Review Board. The Knowledge to Action framework was used to guide implementation of screening, prediabetes identification, management, and referral process. The outcomes were to measure the number and percent of screenings performed after provider education on prediabetes screening, those at risk for prediabetes, and the evidence-based interventions providers chose for management. The prediabetes risk assessment tool (PRAT) was the “Are you at risk for Type 2 Diabetes?” It was administered in both English and Spanish to adults who were not pregnant and had no previous diagnosis of Type 1 Diabetes Mellitus or T2DM. The preferred interventions included referral to a nutritionist, encourage 5%-7% total body weight loss, and/or 150 minutes of exercise per week. The PRAT and interventions data were coded, extracted into SPSS Version 25, and analyzed. Descriptive statistics were used to report patient characteristics, quantity of screenings performed, evidence-based recommendations offered, and patient risk factors for prediabetes. Results: In both clinics, 41% (n=269) of patients screened were found to be at risk for prediabetes. The most self-reported risk factor for prediabetes was family history of T2DM. Healthcare providers mostly provided education on weight loss and exercise, and recommended/referred less than 20% (n=49) of patients for nutritional education. The screening rates in the clinics were 52% (n=92) at site A and 72% (n=177) in site B, falling below the goal of 100%. Conclusions: There remains a gap in provider knowledge and use of evidence-based recommendations to decrease patients’ risk for prediabetes. The authors project that implementation of the PRAT and evidence-based interventions in the electronic health record would positively impact future screening results. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

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Monitoring Prediabetes Screening in Two Primary Care Clinics in Rural Appalachia: A Quality Improvement Project

Introduction: Prediabetes is major risk factor for the development of Type 2 Diabetes Mellitus (T2DM). One-third of the population in the United States has prediabetes, but 90% remain undiagnosed because healthcare providers are not performing screenings, making this a public health challenge. The purpose of this process improvement project was to implement prediabetes screening, prediabetes identification, and a referral process to a nutritionist to prevent or delay the onset of T2DM in patients in two Federally Qualified Health Centers. Methods: This was a quality improvement project conducted over a six-week period after receiving exemption from the University’s Internal Review Board. The Knowledge to Action framework was used to guide implementation of screening, prediabetes identification, management, and referral process. The outcomes were to measure the number and percent of screenings performed after provider education on prediabetes screening, those at risk for prediabetes, and the evidence-based interventions providers chose for management. The prediabetes risk assessment tool (PRAT) was the “Are you at risk for Type 2 Diabetes?” It was administered in both English and Spanish to adults who were not pregnant and had no previous diagnosis of Type 1 Diabetes Mellitus or T2DM. The preferred interventions included referral to a nutritionist, encourage 5%-7% total body weight loss, and/or 150 minutes of exercise per week. The PRAT and interventions data were coded, extracted into SPSS Version 25, and analyzed. Descriptive statistics were used to report patient characteristics, quantity of screenings performed, evidence-based recommendations offered, and patient risk factors for prediabetes. Results: In both clinics, 41% (n=269) of patients screened were found to be at risk for prediabetes. The most self-reported risk factor for prediabetes was family history of T2DM. Healthcare providers mostly provided education on weight loss and exercise, and recommended/referred less than 20% (n=49) of patients for nutritional education. The screening rates in the clinics were 52% (n=92) at site A and 72% (n=177) in site B, falling below the goal of 100%. Conclusions: There remains a gap in provider knowledge and use of evidence-based recommendations to decrease patients’ risk for prediabetes. The authors project that implementation of the PRAT and evidence-based interventions in the electronic health record would positively impact future screening results. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.