Optimizing Annual Urine Microalbumin Screening For T1DM Patients in Diabetes Clinic
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Optimizing Annual Urine Microalbumin Screening For T1DM Patients in Diabetes Clinic

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Optimizing Annual Urine Microalbumin Screening For T1DM Patients in Diabetes Clinic

  1. 1. Optimizing Annual Urine Microalbumin Screening For T1DM Patients in Diabetes Clinic Methods Discussion Aim To Increase the % of T1DM patients (Age ≥ 10 years, T1DM for ≥ 5 years) screened yearly for urine microalbumin in our T1DM clinic from 64% to 97% by June 30, 2015 and sustain until 12/31/2015. . Results References Background Patients with Type 1 Diabetes Mellitus (T1DM) are prone to develop chronic renal failure/nephropathy. This is related to the level of diabetes control and duration of disease. Guidelines have been developed to detect the early onset of nephropathy with annual urine microalbumin screening. ADA and ISPAD recommend: annual urine microalbumin screening for T1DM patients ≥ 10 years of age and with T1DM duration of ≥ 5 years. The challenges around achieving this recommendation primarily involve: provider unawareness, patient unawareness or failure of patients to go to the lab for urine collection. At our institution, we found that only 64% of our eligible patient population was getting the appropriate recommended screening. Achieving early screening as recommended would translate to early detection and implementation of early treatment, thus mitigating progression of nephropathy. Therefore, at our institution we undertook this Quality Improvement Initiative to optimize annual urine microalbumin screening for all our T1DM patients followed in our T1DM clinic. • ADA Standards of Care. Microvascular Complications and Foot Care. Diabetes Care 2015;38(Suppl. 1):S58–S66 | DOI: 10.2337/dc15-S012 • ISPAD Clinical Practice Consensus Guidelines 2014 Compendium. Microvascular and macrovascular complications in children and adolescents. Pediatric Diabetes 2014: 15 (Suppl 20): 257-269. Acknowledgements We would like to thank members of the Diabetes Team in the Section of Endocrinology at our institution as well as our Quality Improvement group for facilitating the success of this initiative. Number of T1DM patients followed in DM clinic screened for annual urine microalbumin: • Pre-intervention: 64% • Post-intervention: 97% Diabetes Care Team members at all levels were educated about this Quality Improvement Initiative and were made aware of the guidelines for urine microalbumin screening in patients with T1DM. A Best Practice Alert was built into the EMR to alert providers at the time of clinic visit for the need of ordering urine microalbumin at the visit. A process flow (see figure) was outlined to clarify this process of screening. As the order was placed in the EMR, labels were printed, LPN was alerted, urine specimen cup was given to the patient, water was provided if needed for hydration, urine sample was collected, container placed in fridge for up to max 1 hour, specimen transported to the lab from clinic. Patients were required to provide the urine sample before leaving clinic so as to ensure specimen collection. Results were followed by the provider and appropriate evaluation made based on test results. • This Quality Improvement project is a part of the overall institution-wide initiative towards journey to best outcomes for our patients. • We demonstrate the success of a comprehensive, multidisciplinary approach to optimizing recommended screening with annual urine microalbumin in patients with T1DM Age ≥ 10 years, T1DM for ≥ 5 years). • Similar strategies may be adapted to achieve success in optimizing recommended health maintenance screenings, not just for patients with T1DM but with other chronic illnesses as well. • Ongoing efforts need to continue to maintain the successful established work flow to achieve best results. Best Practice Alert in Electronic Medical Record Health Maintenance Advisory: This patient is a candidate for urine microalbumin screening “Name of Patient” has met the criteria for annual urine microalbumin screening. Diagnosis: Type 1 Diabetes Mellitus Has this patient been diagnosed with diabetes for 5 years or more? Yes Click Accept to enroll the patient in the health maintenance plan. Uncheck the box to not enroll them in the plan Last urine microalbumin: “date” Not A Candidate: Acknowledge reason Accept or Cancel If Accepted: Order urine microalbumin, order placed and signed by provider 1Nationwide Children's Hospital, Section of Endocrinology, 2Nationwide Children’s Hospital, Business Process Improvement; 3 Nationwide Children’s Hospital at The Ohio State University, Section of Pediatric Endocrinology. Columbus, OH. USA. H. Larson1, D. Vanlandingham2, K. Obrynba3, S. Kara1, M.K. Kamboj3