Abstract
Purpose: The purpose of this quality improvement project is to improve care and management of type 2 diabetes mellitus in the primary care setting with use of collaborative care and utilization of an action plan.|Background: Utilization of goal setting with an action plan developed by the patient and provider has been shown to improve patient management of diabetes as well as confidence in self-management of their disease (Kangovi, et al., 2016; Langford, et al., 2007; & O’Donnell, et al., 2018).|Sample/Setting: This quality improvement project included 20 patients with a diagnosis of type two diabetes who were seen by their primary care provider for management of type two diabetes mellitus.|Methods: Each patient had two scheduled visits for type two diabetes management. A SMART goal was created during the first visit and evaluated during the second visit to determine level of attainment. Additionally, objective findings including blood pressure, weight, BMI, and hemoglobin A1c were all obtained and observed for change. A referral to diabetes education could be made at either visit if the provider and patient felt necessary or if the patient’s A1c was greater than 8%.|Results: A total of nine patients developed a SMART goal to work on during the initial visit. Only one patient achieved their goal. There were no statistically significant changes noted in A1c, blood pressure, weight, or BMI. While there was a total of four patients who qualified for a referral to diabetes education with an A1c greater than 8%, only one referral was actually made.|Conclusion: This quality improvement project demonstrates the importance of individualized patient centered care. Collaborative care should be performed by the provider, patient, and other disciplines including diabetes education to help patients create individualized goals to achieve optimal health and avoidance of complications. A more structured referral process to services such as diabetes education should be investigated to further enhance resources available to those with type two diabetes mellitus.