Rural primary care: Implementation of a screening tool to improve care

Purpose: The purpose of this project was to implement the American Diabetes Association (ADA) Diabetes Risk screening tool and measure adherence to the Diabetic Plate patient education protocol in a rural, primary care clinic in North Carolina (NC). Sample: The setting of the project was a small, outpatient, rural primary care clinic in Western NC that serves a town population of 7,492 persons. Those of any age with a BMI > 25 were eligible for screening. During implementation, 334 patients were seen, and 157 met eligibility criteria. Method: The participating healthcare provider and medical assistants administered the ADA screening tool to eligible patients during their visits. If the patient scored a five or higher, indicating high risk for diabetes, the provider would then provide ADA Diabetes Plate education to inform patients of early T2DM prevention techniques. Completed screening tools were collected bi-weekly and charts reviewed to assess provider and staff adherence with screening. Findings: Out of the 157 eligible patients, 89 patients were screened utilizing the diabetes risk assessment tool. Of the patients screened, 41 were deemed “high risk” and 32 of them received diabetes plate education from the provider. The participating provider and clinic were able to screen eligible patients utilizing the diabetes risk screening tool with a 56.69% success rate and 78.04% of high-risk patients received diabetes plate education. Conclusions: Limitations of the project included inconsistent screening and discrepancies between paper screening forms and EHR documentation. Despite limitations, final data suggests that implementation of the ADA diabetes risk assessment tool could be beneficial in rural regions where ease of access and affordability is paramount. Additionally, implementation of this easy-to-use tool within an existing EHR would likely improve staff screening compliance and improve patient follow-up.