Implementation and Evaluation of Emergency Department Hemoglobin A1C Testing as a Population Health Initiative

Area of Science:

• Internal Medicine
• Public Health
• Health Informatics

Background:

• Hemoglobin A1c (HbA1c) monitoring is crucial for managing diabetes and improving patient outcomes.
• The effectiveness of emergency department (ED)-based interventions for HbA1c monitoring in meeting institutional quality metrics remains unclear.

Purpose of the Study:

• To evaluate a program designed to enhance HbA1c measurement among at-risk patients in the ED.
• Assess the impact of an ED-based intervention on HbA1c testing rates and patient outcomes.

Main Methods:

• A retrospective observational pre-/poststudy was conducted at an academic medical center.
• An ED Information System (EDIS) alert prompted HbA1c orders for overdue diabetic patients.
• Data spanned from January 2017 to September 2023, focusing on HbA1c ordering and follow-up testing.

Main Results:

• HbA1c ordering for targeted ED patients increased from 1.5% to 12.1% post-intervention (p < 0.001).
• Testing rates decreased over time, and only 23% of patients with ED-ordered HbA1c had available follow-up testing.
• The average HbA1c decrease was not statistically different between pre- and post-intervention groups.

Conclusions:

• A targeted ED intervention successfully increased HbA1c testing but showed a diminishing effect.
• The program proved operationally feasible but did not significantly improve HbA1c levels compared to the general ED population.
• Further research is necessary to determine optimal strategies for ED-based population health interventions for chronic diseases.