Assessment of adherence to American Diabetes Association guidelines and evaluation of social determinants of health and interventions in patients with type 2 diabetes mellitus in a nurse practitioner-owned clinic

BACKGROUND: This was an ongoing quality-improvement (QI) project that aimed to assess the quality of nurse practitioner (NP)-driven diabetes care based on the 2023 American Diabetes Association (ADA) Standards of Care (SOC) at a NP-owned primary care practice. In addition, a more recent focus was the assessment of and intervention on social determinants of health (SDOH). Nationally, 47.4% of people with diabetes mellitus (DM) have an HbA1C of >7.0%. Adherence to ADA SOC for DM management minimizes the risk of diabetes-associated complications. 

LOCAL PROBLEM: At a NP-owned clinic, within one year, the average A1Cs improved in all patients except those with positive SDOH despite receiving similar care. SDOH predicts DM prevalence and severity of progression, yet screening is not consistently performed or documented. 

METHODS: An ongoing retrospective chart review since 2013 has assessed adherence to ADA SOC among adult patients with type 2 DM at an NP-owned practice. Multiple Plan-Do-Study-Act (PDSA) cycles have resulted in new recommendations that have promoted adherence to diabetes metrics and improvement in overall mean A1C. 

INTERVENTIONS: The current PDSA cycle emphasizes the creation and implementation of evidence-based interventions to assist NPs in addressing social needs at a NP-owned practice. 

RESULTS: Recent data collection has included frequency of SDOH screening, identifying social needs, gaps in SDOH documentation, and has found overall higher A1Cs in patients with positive screens. 

CONCLUSIONS: Project intervention of social workers collaboration with NPs resulted in improvement in addressing social needs in patients with type 2 diabetes mellitus.