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Diabetes Flow Sheet Use Associated With Guideline Adherence

¹ UMDNJ – Robert Wood Johnson Medical School, Department of Family Medicine, Somerset, New Jersey
² UMDNJ – New Jersey Medical School, Department of Family Medicine, Newark
³ The Cancer Institute of New Jersey, New Brunswick

CORRESPONDING AUTHOR: Karissa A. Hahn, MPH, Department of Family Medicine, UMDNJ-RWJMS, 1 World’s Fair Dr, 1st Floor, Somerset, NJ 08873, clarkeka{at}umdnj.edu

PURPOSE Many intervention studies have found that flow sheet use improves patient care by drawing attention to a particular medical condition or needed preventive service and encouraging an immediate response from the health care professional; however, there are no studies examining how often flow sheets are used for diabetes in primary care practice. We assessed the relationship between diabetes flow sheet use and diabetes patient care outcomes in the everyday practice of primary care.

METHODS We abstracted the medical records of 1,016 patients with diabetes seen at 54 New Jersey and eastern Pennsylvania family practices participating in a quality improvement trial. The use of diabetes flow sheets was noted for each medical record. Scores for adherence to evidence-based diabetes guidelines in terms of assessment, treatment, and target attainment were determined on 100-point scales, with higher scores indicating better adherence. Generalized linear models were used to determine associations between use of diabetes flow sheets and adherence to guidelines.

RESULTS Diabetes flow sheets were used in 23% of the medical records of patients with diabetes. Use of flow sheets was associated with better mean guideline adherence scores for the assessment of diabetes (55.38 vs 50.13, P = .02) and the treatment of diabetes (79.59 vs 74.71, P = .004), but not for the attainment of intermediate diabetes outcome targets (hemoglobin A_1c level, low-density lipoprotein cholesterol level, and blood pressure).

CONCLUSIONS Diabetes flow sheets can be used to promote better adherence to guidelines when it comes to assessing and treating diabetes. Additional research is needed to explore patient and physician variables that mediate the relationship between use of diabetes flow sheets and intermediate outcome targets for diabetes.

Key Words: Flow sheets • diabetes mellitus • family practice • guidelines • assessment • treatment • outcomes • primary care • quality of health care • process assessment (health care) • medical record review

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