Improving monitoring of diabetic complications in home care patients

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.

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.

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.

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