Improving Referrals to Diabetes Self-Management Education in Medically Underserved Adults.

OBJECTIVE: Electronic health records (EHRs) and clinical decision-support algorithms improve diabetes care. This quality improvement (QI) project aimed to determine whether an electronic diabetes education referral protocol using the Diabetes Self-Management Education and Support for Adults With Type 2 Diabetes: Algorithm of Care (DSMES Algorithm) and protocol training would increase the proportion of adult patients with type 2 diabetes at a federally qualified health center electronically referred for diabetes self-management education and support (DSMES). DESIGN AND METHODS: The EHR was modified to include the DSMES Algorithm and questions regarding prior participation in diabetes education. Protocol trainings were conducted. Data were obtained via retrospective chart review. A one-sample t test was used to evaluate the statistical difference between the electronic referral (e-referral) rates of the pre-intervention and intervention groups.
RESULTS: Completion of the DSMES Algorithm was positively associated with e-referrals to diabetes education (P <0.001). The intervention group had a higher rate of e-referral for DSMES than the pre-intervention group (31 vs. 0%, P <0.001).
CONCLUSION: E-referral protocols using the DSMES Algorithm and protocol training may aid in the identification and documentation of self-care needs of medically underserved patients with type 2 diabetes and improve e-referrals to DSMES. Of clinical importance, these findings translate into active patient engagement, team-based care, and information-sharing. Additional work is needed to determine whether the e-referral rate is sustained or increases over time. Further investigations should also be explored to evaluate the impact of e-referral protocols and algorithms on participation in DSMES.