Targeted Approach Using the Chronic Care Model Improves Glycemic Control Among Registry Patients

In 2009, North Central Bronx Hospital analyzed data from its diabetes registry to identify opportunities for improving glycemic control. Of the 2,000 patients, only 22 percent had achieved glycemic control of glycated hemoglobin (A1c) of less than 7 percent. The hospital also found 25 percent had A1c between 7 and 7.9 percent, and another 10 percent achieved the A1c goal but had not been tested within 180 days. In a random chart review of 100 patients with A1c between 7 and 7.9 percent, 10 percent were not prescribed any medications and 40 percent were on monotherapy. These groups, comprising about 35 percent of the registry patients, were the focus of multifactorial interventions using the chronic care model. Comprehensive strategies included expanding the role of the patient care associate; improved access to care; focused visits; pharmacist-run medication adherence and insulin titration sessions; provider clinical decision support through protocols, guidelines, and rapid A1c testing; patient self-management training; community referrals; and aggressive outreach.