Use of Point of Care Testing to Affect Clinician Treatment Decisions for Patients with Diabetes
Brow, Shannon I.
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This process improvement initiative implemented a policy for medical assistants (MAs) to perform and record point of care (POC) glucose test results in the electronic medical record (EMR), for all patients with diabetes during clinic check-in. Actions and behaviors of practice staff were evaluated to determine how POC results affected clinician treatment decisions. A retrospective review of staff recorded (EMR) data was assessed at baseline, after a 2-week run-in, and 4-weeks prospectively. This initiative was implemented in a small group internal medicine practice, treating predominantly low-income, Hispanic immigrant patients in Texas. Staff include six medical assistants, three physicians, and two nurse practitioners. Primary outcomes assessed include MA adherence to the policy and clinician treatment decisions from EMR documentation. Diabetes prevalence was 54.2% in this practice. Medical assistant POC glucose tests were documented for 26.6% (103/387) of patients at baseline and 52% (178/342) of patients after policy implementation. Detailed clinical decision data collection was performed for every tenth record, the evaluated sample n = 34 of 342 records. POC glucose levels were recorded for 38.2% (13/34) of the sample. Clinician treatment decisions changed 23.1% (3/13) of the time when POC results were available. The number of POC glucose tests doubled after policy implementation, yet half of patients did not have POC glucose tests performed. Clinician treatment decisions occurred more frequently when POC glucose values were greater than 200 mg/dl at the time of the clinic visit.
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