Abstract
With the increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, pediatric primary care providers need to utilize evidence-based screening for early identification of at-risk children. By exploring the literature of adolescent T2DM, the clinical practice problem of the lack of or delay in screening at risk children is apparent. This quality improvement project aimed to increase the rate of evidence based screening of T2DM in children at local pediatric primary care clinics by updating an electronic medical record best practice advisory flag and prompting providers to order a hemoglobin A1C. The screening recommendations are based on guidelines recommended by the American Academy of Pediatrics (AAP) and American Diabetes Association (ADA). Risk factors in the reminder will include youth age 10 years and older who are overweight (BMI ≥85%) or obese (BMI ≥95%) with one or more of the following factors: 1) maternal history of diabetes or gestational diabetes 2) a 1st or 2nd degree relative with type 2 diabetes 3) race (Native American, African American, Latino, Asian American, or Pacific Islander) 4) signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome or small-for-gestational-age birth weight). Data collection was completed by assessing the number of EMR flags and the number of HgA1Cs ordered over a two-month period in the Winter of 2019. Post-intervention screening rates were compared to the same months the previous year. Descriptive statistics was utilized to analyze the data. Basic demographic information including age, BMI, and risk factors were analyzed. After a two-month period, the use of the EMR Best Practice Advisory appeared to improve screening practices. The clinics experienced an increase in HgA1C orders from 20 the previous winter to 45 after implementation.