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Background/Rationale: The prevalence of pediatric T2DM continues to escalate, increasing from 9% in 1999 to 23% in 2008. Minimal, or absence of, screening leads to insufficient detection of the disease, increased diabetes exposure, and increased risks for long-term complications. Poor screening can be attributed to the lack of provider adherence to clinical practice guidelines (CPG), including diabetes screening guidelines. Computerized protocol sets, provider reminders, and patient cues have been shown to increase provider adherence to CPG. According to the American Diabetes Association (ADA), as many as 62% of children eligible are not screened. In the project facility, there was no screening protocol in use.
Best Practice: The purpose of this evidence-based practice project is to increase provider screening for T2DM by 10% at a pediatric primary care clinic in southern California. A multi-faceted approach was implemented, including the incorporation of a computerized T2DM screening protocol based on ADA guidelines into the electronic medical record system. Paper-based provider reminders on ADA screening criteria were also displayed in provider workspaces, while visual patient cues regarding screening eligibility were displayed in the waiting and patient rooms. The screening rates for T2DM based on ADA criteria were determined three months before and after implementation.
Outcomes: In progress. Upon completion of the project, it is anticipated there will be at least a 10% increase in provider screening for T2DM patients at the pediatric primary care clinic.
Conclusions: A multi-faceted approach should increase provider adherence to ADA guidelines for screening T2DM in children. Increased T2DM screening in children should increase detection of the disease, yielding greater opportunities for early interventions, and decreased morbidity and mortality in this increasingly susceptible population.
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