Rita Louard, MD, FACE
The Sweethearts Quality Improvement Program, a comprehensive, multidisciplinary diabetes outpatient treatment program, was implemented in 2004 in the Adult Medicine Practice of the Family Care Center, one of Montefiore Medical Center’s internal medicine resident ambulatory practices. The Sweethearts QI Program incorporates enhanced delivery system design, decision support, self-management support, and clinical information systems to effectively treat patients with chronically uncontrolled diabetes (HbA1c >9%).
Designed to meet the challenges of a busy ambulatory teaching practice, with rotating part-time medical residents and often fragmented diabetes care services, the Sweethearts Program united a range of providers in a team led by a faculty primary care physician and consisting of a rotating medical resident, nutritionist, and licensed practical nurse trained in diabetes education. Patients meet individually with each team member, with follow-up visits every 2 weeks until optimal glycemic control is achieved (up to four months).
An integral goal of the Sweethearts Program is effective medical resident training of medical residents. Patients meet with medical residentsfor approximately half the visit to discuss glycemic control, medication use, and recommended diabetes care processes (e.g., visits to a podiatrist and ophthalmologist). Residents use progress notes pre-populated with point-of-care reminders to reinforce best diabetes care practices and streamline documentation. After the sessions, medical residents review landmark trials with faculty preceptors and discuss how to directly translate evidence-based-medicine to their patients.
Patients in the program spent the remaining half of the visit learning practical information and diabetes management techniques. Nurses address barriers to medication adherence and provide instruction on insulin administration and blood glucose monitoring. The nutritionist discusses culturally appropriate diabetes meal plans. Following each visit, the team discusses each patient, sharing perceived barriers to optimal glycemic control and generating individualized care plans.
The Sweethearts Program utilizes pre-existing electronic medical records (EMRs), allowing real-time provider access to patients’ visit history, laboratory values, and imaging studies.
Patients in the program have demonstrated reductions in HbA1c levels.
Program administrators are currently evaluating a resident "diabetes report card" promoting appropriate laboratory follow-up and medication escalation.