Exploring point-of-care transformation in diabetic care:A quality improvement approach

Objective:This quality improvement project evaluated the impact of a point-of-care(POC)HbA1c stat lab intervention and a nurse-assisted expanded visit implemented among patients with uncontrolled type 2 diabetes(T2D)at a community health center in Houston,TX.Methods:This was a before-and-after POC intervention among adult patients who received primary care services between 1 July 2014 and 31 December 2014(baseline visit)and who had at least one 3-month follow-up visit.Results:Three hundred eighty-seven patients were included in the study.The majority were<60 years of age(72.1%),female(60.5%),and Hispanic(63%),followed by black(16.5%)and Asian(11.1%).Almost 87%of the patients had uncontrolled T2D(HbA1c>9%)at baseline,with the highest average levels among Hispanic(10.9%)and black(10.7%)patients.There was a significant difference in the HbA1c level before(mean=10.65,SD=1.9291)and after(mean=9.25,SD=1.8187)intervention.The absolute reduction in the level of HbA1c was 1.4%(t=12.834,p<0.001),corresponding to a 13%overall percentage decrease from baseline.Conclusion:There is a distinct advantage in using a stat HbA1c lab when combined with shared POC visits to assist patients with uncontrolled T2D in lowering the HbA1c,improving self-management,and reducing long-term costs.

Self-reported preferences for patient and provider roles in cancer treatment decision-making in the United States

Objective:To describe differences in preferred roles in cancer treatment decision-making and identify associated sociodemographic and health-related factors among adults in the United States.Methods:We conducted a cross-sectional analysis of nationally representative data from the 2014 Health Information National Trends Survey.Descriptive statistics were calculated and multi-variable logistic regression was conducted to examine associations.Results:Half(48.3%)of respondents preferred a collaborative role in decision-making under the supposition of a moderate chance of survival;while 53.4%preferred a more active role when the chance of survival was low.Approximately 7%-8%indicated a preference for a passive role in decision-making,for both low and moderate chances of survival.Several predictors of role prefer-ence for cancer treatment decision-making emerged,including age,sex,education,race/ethnicity,and having a regular health care provider.At both low and moderate chances of survival,the col-lege educated were less likely to prefer a passive role,whereas Hispanics were two to three times more likely than whites to indicate a preference for a passive role.Conclusion:Adults’role preference for cancer treatment decision-making may be influenced by sociodemographic and health-related factors.Increased awareness of these factors,paired with enhanced patient-provider communication,may assist health care professionals in providing indi-vidualized and high-quality,patient-centered cancer care.