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Improving monitoring of diabetic complications in home care patients
  1. Wahila Alam1,
  2. Shirmila Syamala1,
  3. Hanadi Al Hamad1,
  4. Sybil George2,
  5. Noorudeen Kunnunmal1,
  6. Fatma Abdelfattah2,
  7. Sunita Chinamma2,
  8. Essa Al-Sulaiti2
  1. 1Department of Geriatrics, Hamad Medical Corporation, Doha, Qatar
  2. 2Home Health Care, Hamad Medical Corporation, Doha, Qatar
  1. Correspondence to Dr Shirmila Syamala, Department of Geriatrics, Hamad Medical Corporation, Doha, Qatar; ssyamala{at}hamad.qa

Abstract

Introduction Uncontrolled diabetes mellitus can lead to microvascular and macrovascular complications. Early detection of complications is necessary to prevent end-organ damage and reduce diabetes-related morbidity. In Qatar, the Home Health Care Services of Hamad Medical Corporation caters to about 1000 patients, who solely depend on home healthcare physicians for primary care coordination, which includes management of chronic medical illnesses such as diabetes, stroke, hypertension and anaemia. Due to physician shortage, different physicians new to home care cover patients on different days. This leads to inconsistency of monitoring for many chronic conditions including diabetes and its complications. In this context, we conducted a quality improvement project to improve compliance to monitoring of diabetes complications in Home Healthcare Services by the implementation of a checklist.

Methods We initially collected baseline data on monitoring of diabetes complications by chart review. Quality improvement principles and methods were employed to develop a checklist-based intervention to improve screening of diabetes complications by healthcare staff.

Results Following the intervention, checklist completion rate improved from 0%–36% in 3 months to 63% in 2 years. The healthcare staff’s knowledge of monitoring for diabetes complications improved significantly across all monitored parameters. Furthermore, the percentage of patients being monitored for diabetes complications (ie, outcomes) also improved substantially. Monitoring for proteinuria and diabetic retinopathy improved from 10% and 17% at baseline to 85% and 74% 2 years postintervention, respectively.

Conclusion In conclusion, quality improvement methods were successfully used to improve monitoring of diabetes complications according to international guidelines in a very vulnerable population.

  • checklists
  • chronic disease management
  • diabetes mellitus
  • PDSA

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors WA: principal investigator, data collection and manuscript preparation. SS: manuscript preparation and review. HAH: manuscript review. SG: manuscript review, data critique and analysis. NK: data collection. FA: data collection. SC: manuscript review. EAS: manuscript review.

  • Competing interests None declared.

  • Ethics approval The work is primarily intended to implement evidenced based care provided to diabetic patients according to the institution’s guidelines which do not require ethical approval. We sought only to evaluate the improvements in compliance with the institutions guidelines as a result of auditing and feedback of compliance.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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