SAT-522 A Multi-disciplinary Care Team Model to Improve Diabetic Bundle Compliance Among Internal Medicine Residents and Providers (Non-Residents)

Abstract Disclosure: S. Zahra: None. H. Marasandra Ramesh: None. P. Wulandari: None. P. John: None. Background: Diabetes is increasing at an alarming rate in the US. Diabetes is the eighth leading cause of death in the US. About 15.9 million or 29.2% of Americans aged 65 or above had diagnosed or undiagnosed diabetes. 38.2 million physician office visits were reported to have a primary diagnosis of diabetes [1]. The national cost of diabetes in the U.S. in 2017 was more than $327 billion up from $245 billion in 2012. The ADA and the ACC started to raise public awareness about the “ABCs of Diabetes”, namely A1C, BP, and cholesterol. The recommended target of A1C is <7% (except for pregnant patients, patients with limited life expectancy, and patients with significant glycemia risk), blood pressure <140/80 mmHg, and LDL <100 mg/dl. As per Standards of Medical Care in Diabetes 2021, A1C should be measured at least twice yearly in patients with stable glycemic control and at least quarterly in patients not meeting glycemic goals. At our institution, we use a composite score, the Diabetic bundle. It consists of diabetic patients seen in the past 2 years who have an active PCP, with an A1C <= 8 in the past 6 months, and who have currently been prescribed a moderate or high-intensity statin (or a statin exemption code), and a negative diabetic eye exam in the past 2 years or a positive exam in the past year, as a system numerator and total diabetic patients seen in the last 2 years who have an active Guthrie PCP, as a system denominator. Goals: Maintain the system goal of bundle compliance >45%. Identify barriers contributing to low diabetic bundle compliance rates in the resident clinic. Interventions: Providing handouts to educate clinical staff about the diabetic bundle quality metrics. Actively participating in morning huddles to address gaps at multiple levels. Identifying the non-complaint patients and attempting to reach them to increase the follow-up rate. Biweekly analysis of compliance; and diabetic registry to be updated regularly. Sending text reminders to patients who are overdue for an ordered A1c. Results: Overall, the diabetic bundle compliance rate remained above 45%. The post-intervention rate was 45.5%. The diabetic retinopathy screening rate increased from 73% to 76.3%. Statin use in the target population increased from 93% to 94.2%. HbA1c screening rates decreased from 63.1% to 58.9%. Conclusion: Patient calls and message reminders were the most useful intervention. Multiple barriers to improving diabetic bundle compliance rates were identified. The compliance rates were noted to drop when residents were posted on busy inpatient rotations. Substantial reluctance was expressed by diabetic patients with no other comorbidities to initiate statin therapy, as part of the diabetic bundle. Most patients performed POCT HbA1c at their endocrinologist's office and data were not automatically uploaded on EPIC from outside facilities, due to which overall bundle rates could have been falsely compromised. Presentation: Saturday, July 12, 2025