Date of Publication
Carol Buck-Rolland Ed.D., APRN; Constance VanEeghen Dr. PH
Diabetes Mellitus Type II Quality Improvement Using the My Own Health Report
Lynn Bennett McMorrow
Rationale: To maintain Primary Care Medical Home status, Cold Hollow Family Practice (CHFP) is mandated to perform continuous quality improvement for chronically ill patients. To achieve this goal at CHFP, a formal quality improvement (QI) process using a validated health risk assessment tool, My Own Health Report (MOHR) was used to engage patients with Type 2 Diabetes (T2D) in dialogue regarding self change behaviors. The goal was to improve patient self-care management as evidenced by decreased HbA1c readings or weight as compared to non-participating patients, over a six-month period.
From 1980 through 2012, the number of adults with diagnosed diabetes in the United States nearly quadrupled, from 5.5 million to 21.3 million and 1.7 million more persons over 20 years of age are diagnosed each year. The estimated direct medical costs in 2012 were 176 billion and the indirect costs (lost wages, disability and death) for the same time frame were 69 billion. Individualized patient care, as the corner stone of evidence based practice, is vital to improve self-management in patients who have Type 2 Diabetes (T2D).
Methods: The QI process began with 27 patients. We had 10 patients who did not participate and 17 who did the MOHR as administered by the medical assistant. The provider reviewed the MOHR summary and used motivational interviewing to discuss the results with each patient scheduled for a T2D visit, for willingness to discuss or change modifiable life styles.
Quantitative analysis was done with Fisher’s Exact Test comparing those who were in the MOHR group to those not participating. Qualitative analysis was not done secondary to time and EHR constraints.
Results: Comparison of the MOHR group to the non-MOHR group, 47% improved both weight and HbA1c whereas the non-MOHR group had 0% improvement (P=0.01). Using the same comparison in HbA1c only, the MOHR group decreased by 58% compared to 10% for the non-MOHR group (P= 0.02).
Conclusions: Generalizability is limited by a number of factors: a small group study of 27 patients and provider use of motivational interviewing and historical patient/provider relationships. Furthermore, it was a self-selected group that may have been ready to change. Without randomization, motivational interviewing, and requiring that the MOHR be completed we cannot absolutely determine the impact of the MOHR on T2D disease marker improvements. Further study using the MOHR report with motivational interviewing is needed to support these findings.
Keywords: Diabetes Type 2, MOHR, HbA1C
McMorrow, Lynn Bennett FNp-C, "Diabetes Type II Quality Improvement Using the My Own Health Report" (2017). College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications. 6.