The impact of using a low-literacy patient education tool on process measures of diabetes care in a minority population.

This study evaluated the current level of diabetes care in three county clinics serving an underserved minority population and determined if a low-literacy, diabetes reminder card would enhance certain diabetes process care measures. Patients from two intervention sites were given the low-literacy, diabetes reminder card. Two-hundred-nineteen patients (87%) showed the card to their provider, and 209 charts were reviewed. American Diabetes Association guidelines had been met 37%, 71%, and 41% for foot exam, and urine and lipid tests, respectively, at the time the card was given to the patients. Of the patients who needed a foot exam, urine test, and lipid panel that day (based on ADA guidelines), 48%, 67%, and 35% received them, respectively (card effect). In the third (nonintervention) site, charts of 218 patients were reviewed. Guidelines met were 95%, 89%, and 45% for foot exam, urine and lipid tests, respectively. Interestingly, standardized progress notes containing the first two (but not the third) process measures were used at this site. We conclude that although low-literacy reminder cards did improve the ordering of process measures somewhat, they were not as effective as the utilization of progress forms with specific diabetes-related measures.