1043-P: Uncovering Root Causes Contributing to Persistent Gaps in Glycemic Control and Effective Weight Management in Patients with Type 2 Diabetes and Obesity

This QI initiative in 2 large US-based community health systems assessed root causes hindering A1C control and weight management in people with T2D and obesity through health care provider (HCP) surveys (n = 29), baseline EMR audits (n = 100), team-based audit-feedback (AF) sessions, and patient-provider collaborative education sessions. Lack of treatment access and delayed treatment intensification were identified as factors contributing to inadequate A1C control. In the survey, 48% of HCPs reported providing treatment access support as a top barrier. Missed opportunities to escalate care were revealed through gaps in key care measures for patients not on target to achieve their A1C goal, including reevaluating current diabetes medication (77% HCPs reported routinely performing) and referring patients to a diabetes care and education specialist (49%). Following the AF intervention, the percentage of HCPs who plan to consider therapy escalation within 3 months increased from 38% to 80%. Following collaborative education, the percentage of patients who reported understanding the importance of achieving their A1C goal increased from 47% to 71% and 81% committed to taking a more active role in their diabetes management and self-care. Gaps were uncovered in weight management counseling, support, and shared decision-making (SDM). Asking patients about treatment goals was documented in 57% of charts. Reporting weight loss goal discussion every 3 months were 60% of HCPs and 33% of patients. Following AF sessions, the percentage of HCPs who plan to prioritize SDM as a top 2 goal increased from 21% to 53% and HCPs committed to updating patient materials to support more productive conversations about individual health goals. Key factors hindering attainment of A1C and weight management goals revealed through this study include gaps in treatment access, treatment intensification, SDM, and weight management counseling, support.