Implementing a Care Plan for Adults with Diabetes in Primary Care

Abstract

The purpose of this DNP scholarly project was to improve the documentation of key elements of Diabetes (DM) care during follow-up visits in a primary care clinic. The project also sought to improve the workflow of DM follow-up visits and assist with clinical decision making at the point of care. An extensive literature review found that clinical decision support systems (CDS) have the potential to improve care of DM patients. Using the American Diabetes Association’s (2018) Standards of Care Guidelines, a care plan template was developed as a CDS in the electronic health record (EHR) that was implemented during follow-up visits. The care plan was implemented into the EHR each week for DM follow-up patients, chart reviews were performed, and the documentation completeness was recorded in a chart audit tool. The care plan template improved documentation compliance in nine out of ten DM care categories ranging from 16% to 78% depending on the category. There were also subjective reports from the provider of improved workflow and assistance with CDS with the use of the care plan. Care plan templates have the potential to improve documentation if implemented in the EHR. Improving documentation can decrease reimbursement delays from insurance companies and may increase incentive payments for certain clinics that qualify. Future projects should focus on evaluating the impact on clinical outcomes and cost effectiveness with the use of care plans in primary care. To improve efficiency, it is recommended that the care plan template be developed into a computerized CDS.