Key steps to make the grade

THREE MAIN ELEMENTS

As much as I bristle against flow sheets and templates, incorporating elements of both of these tools into the way I manage diabetes has improved the care I provide to my patients. I have developed three main strategies that remind me to pay attention to the important parts of diabetes management, to document my care plan, and to invite the patient into the loop as an active participant.

This report card is not a novel idea; different versions are in use. But the report card I developed is purposely limited so that the items I consider the most important are emphasized to my patients. I also find that patients often forget what the hemoglobin A_1C or microalbumin is and why we measure it. Therefore, I keep the full description of the test on the report card so that they will remember their goal and also why I check it.

The second item I incorporate into my practice is a diabetes data set. Unfortunately, our EHR does not link with our lab results, so everything needs to be manually entered. Documenting this data set at every visit quickly highlights what is overdue or neglected (for instance, no cholesterol check in the past 18 months), draws all of the data together in an easy-to-read format, and emphasizes to clinical support staff what is important in diabetes care.

I keep the data set relatively brief and focused so that it is a useful tool and not unnecessarily cumbersome. Now that we use an EHR, the diabetes data set can be easily cut and pasted back and forth from the problem list, ensuring that the patient's record is updated at each visit and each time a new lab result or eye exam report comes into my clinic.

My diabetes data set includes the following elements: