CHSU Discovery

Abstract

This quality improvement study targets the critical issue of annual diabetic foot exam compliance in a residency clinic, set against the backdrop of rising lower extremity amputations among diabetic patients nationally. In California alone, the rate of diabetes-related amputations surged by over 40%from 2009 to 2016, with a corresponding increase from 1,081 to 1,552 cases per 100,000 diabetes related hospitalizations. Despite the reported statewide foot exam compliance rate of 72.1%between 2013 and 2016, falling short of the CMS national benchmark of 76.17%, our clinic has historically recorded even lower rates. The study introduced a comprehensive intervention strategy, aiming to not only meet but exceed the national compliance figures. The multifaceted approach included educational initiatives for residents in didactics sessions, EHR (Cerner) protocol integration, and a dual reminder system for both healthcare providers sent out as monthly texts and patients in every visit. The impact of these interventions was measured over a six-month period. Post-intervention data revealed a substantial increase in compliance rates, rising to 79.2%, and a significant improvement in the documentation accuracy of foot exams in the ad hoc section of Cerner. Patients who already had established care with a podiatrist and medical providers not logging the exam details in EMR (Electronic Medical Records) were limiting factors in further improvement. The study advocates for the replication of such interventions in similar healthcare settings, emphasizing the role of education, reminders, EHR optimization, and proactive patient engagement in improving diabetic foot care and reducing the risk of amputations.