Sandy Hanson

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Efficacious diabetes management in a free clinic setting is a challenging, costly, and labor-intensive process that requires established proficiencies to achieve American Diabetes Association (ADA) clinical guidelines. An electronic health record (EHR) template was created that includes a pneumonic based on the Alphabet Strategy to prompt providers to use the current diabetes clinical practice management guidelines. The alphabet strategy pneumonic is evidence-based for use in underserved populations and includes seven components based on the American Diabetes Association diabetic clinical practice guidelines: advice; blood pressure, cholesterol/creatinine; diabetes control; eye exam; foot exam; and guardian drugs. The implementation is based on the Chronic Care Model that aids individuals with chronic diseases to provide self-care, improves interactions between patient and provider, and facilitates data collection to improve care across community health systems, clinical practice, and the patient. Project outcomes measured include formal and informal assessment of provider template use, and feedback on the implementation process with descriptive and qualitative data analysis. The alphabet strategy EHR template showed improvement in cholesterol screening, creatinine screening, diabetic eye exam, and the foot exam including pulses and deep tendon reflexes. Overall the EHR template did not show significant improvement in the documentation of the seven facets, it did allow for a summarization of the core components of quality diabetic care. The Covid-19 pandemic caused significant barriers and contributed to less comprehensive diabetic visits.

Author Supplied Keywords

diabetes mellitus, uncompensated care, medically uninsured, checklists-utilization, quality improvement


Medically uninsured persons--Medical care--United States; Medical records--Data processing; Diabetes; Diabetes clinics

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Copyright for this work is retained by the author.

Document Type

Doctoral Project