Diabetes Care at the University of Colorado Hospital
University of Colorado Hospital has devoted significant resources to measure and improve quality of care for patients with diabetes.
The initiative is called "Advancement of Diabetes Care." Education for staff and providers, clinical tools such as insulin order sets, and data collection help us monitor and improve our care and practices.
Care in the Office
Insurance plans use a "report card" to measure the quality of care provided in office settings. This report card is produced by the Health Care Effectiveness Data and Information System (HEDIS), which is published by the National Committee for Quality Assurance. We use the HEDIS report information to evaluate how well we are performing compared to national trends. After we evaluate our quality data, we develop system-wide improvements to care.
Controlling our patients' diabetes
For example, we monitor how well our Primary Care and Endocrine Clinics control our patients' hemoglobin A1C. This is an important blood test that shows how well a patient's diabetes is being controlled. The test provides an average of the patient's blood sugar levels over a two month period.
If the blood sugar levels have been high, the hemoglobin A1C will be high. Poor control is defined as an A1C greater than 9%. Patients having an A1C of greater than 9% are more prone to diabetes-related complications - so in the chart below, "lower" is better.
We use the HEDIS information to compare our patients' overall A1C results to other offices across the country. According to the 2010 HEDIS Report, the percentage of our patients in poor control (A1C > 9%) is significantly lower than national trends.
Care in the Hospital
For most patients with diabetes who are hospitalized, the main reason for admission is a clinical condition other than diabetes. But evidence shows it is important to manage blood sugar levels at all times.
One of our goals has been to diminish the use of an older type of insulin therapy (regular sliding scale insulin) with an improved rapid acting insulin that is more appropriate for most patients. Over a two year period, we have drastically changed the ordering patterns — over 90% of our patients now receive the rapid acting insulin.
In addition, we have provided advanced diabetes education to hundreds of physicians and nurses and have developed diabetes-specific clinical resources and tools.