Development of a Diabetes Registry as a Quality Improvement Tool for Assessing Access, Service Utilization and Health Outcomes in Economically Vulnerable Populations

Adoption of the electronic medical record in health care has been shown to strengthen clinical decision support, optimize delivery of care, and reduce healthcare costs. Disease registries are comprised of a searchable list of all patients with specific chronic conditions that often interface with an electronic medical record. A registry can serve as a quality improvement tool/decision support methodology that can provide timely and efficient identification of high-risk subpopulations. This can then permit the health care team to implement appropriate clinical care protocols. In Bexar County, Texas, 14 percent of the adult population has been diagnosed with diabetes. When compared to other counties in Texas, Bexar County. It estimated that by 2040, 25% of the adult residents will have diabetes. The Texas Diabetes Institute, a member of University Health System (UHS) a major safety-net hospital with a service catchment of 1.7 million residents, in partnership with the Research to Advance Community Health (ReACH) Center and representatives from the Department of Information Systems at UHS undertook an effort to design and analyze a registry of 47,000 patients diagnosed with diabetes between 2010 and 2011. Design and utilization of a diabetes registry is considered the first step in providing a data analytic platform by which to fully evaluate variation in access and delivery of diabetes care measures (HbA1c, blood pressure, LDL control), as well as clinical preventive services and their impact on condition-specific outcomes for patients with diabetes. This effort is also considered central to UHS' meeting the standards and elements required to achieve Level 3 National Committee for Quality Assurance (NCQA) PCMH Recognition. Information provided will report on progress as well as challenges and opportunities involved in development of a registry system aimed at identifying service gaps associated with continuity of care especially among high-risk, economically vulnerable populations.