Improving diabetes care using a multitiered quality improvement model.

The authors report the results of implementing a diabetes mellitus guideline in a group practice in which uniform, technology-generated care processes were produced for patients, clinical staff, and providers. The objective was to increase the annual rate of recommended tests and examinations for patients with diabetes and to reduce levels of glycosylated hemoglobin, blood pressure, and low-density lipoprotein cholesterol. A process change for type 2 diabetes mellitus was implemented that included changes in office visit structure, protocol-driven electronic prompts for nursing and physician staffs, clinical decision support built into a new electronic medical record form, and audit with feedback.