Evaluating the effect of COVID-19 on quality measures of patients with type 2 diabetes in two family nurse practitioner-owned clinics.

ABSTRACT

BACKGROUND: The COVID-19 pandemic necessitated lockdowns resulting in the disruption of access to primary care. A family nurse practitioner (NP)-owned practice shifted many visits to telehealth to provide care to all their patients including those with chronic illness . The purpose of this project was to evaluate the impact of the pandemic on selected diabetes quality measures and adherence to national diabetes guidelines in two previously well-performing NP-owned primary care clinics. LOCAL PROBLEM: Previous quality improvement studies demonstrated high performing metrics for their patients with type 2 diabetes mellitus (DM). The evaluation of the patients with type 2 DM was necessary to assess the care being delivered in the practice. METHODS: A retrospective record review and analysis of 179 patients older than 18 years was implemented during the early days of the pandemic. Demographic data, process, and outcome measures for diabetes care were collected and compared with previous data from 2013 to 2017 to identify gaps in care. INTERVENTIONS: Telehealth was implemented to deliver care to patients because of the lockdown. The evaluation of these metrics during the period where telehealth was being used to provide care was warranted to evaluate the status of patients with type 2 DM. RESULTS: Patients with type 2 DM receiving care with telehealth demonstrated worsening A1cs and other quality care measures, including fewer ophthalmology evaluations. CONCLUSION: While access to telehealth was important for these patients with type 2 DM, the findings demonstrated that the COVID-19 pandemic had a negative impact on diabetes quality measures. While these may have also reflected the challenges of adhering to lifestyle interventions during this stressful time, telehealth alone may not be an adequate delivery mechanism for primary care for those with type 2 DM.