Abstract
Background and Purpose: Diabetes mellitus (DM) is the 7th leading cause of death in the U.S. and a $245 billion chronic condition to manage annually. Diabetic foot ulcerations (DFU) are one of the most common and costly complications of DM. The purpose of this quality improvement (QI) project was to improve detection of diabetic foot complications by implementing a protocol to increase frequency and documentation of diabetic foot examinations by primary care providers (PCPs) at a Federally Qualified Healthcare Center (FQHC).|Methods: An in-service review of the diabetic foot examination with proper EMR documentation was held for PCPs and medical assistants (MAs). Following a retrospective chart review, a list of 278 diabetic patients from July to September 2020 with a gap in care for diabetic foot examinations was generated. An attempt to contact and schedule these patients was made, and 180 were seen in-clinic or via telehealth from mid-September to December 2020. In December 2020, these charts were reviewed to determine if the diabetic foot examinations were completed and properly documented.|Results: Pre-intervention data from Q4 2019 showed 43% of patients had a documented foot examination. Of the 180 patients seen from mid-September to December 2020, 127 patients received the diabetic foot examination, self-check education, or a podiatry referral – all with proper EMR documentation. The data demonstrates that 71% received some form of diabetic foot ulceration intervention with proper documentation in the EMR. This shows a 28% increase and is statistically significant at p < 0.001.|Implications for Practice: Streamlining the EMR workflow and creating a checklist style approach to documenting the diabetic foot examination could increase performance, with proper documentation, of the diabetic foot examination. The intervention significantly improved the number of patients who not only received some form of intervention but also proper documentation. The use of CPT II codes specific to the diabetic foot examination was implemented as a result of the project and will be useful for outside organization tracking purposes in the future. The opportunity for financial incentives through value-based contracts (VBCs) specific to the diabetic foot examination are an added value when implementing methods to better meet standards of care and clinical quality measures (CQM). Without limitations due to the COVID-19 pandemic including limited accessibility, high staff turnover, and pandemic restrictions, implementation of the protocol would likely produce even better results.