title: Chronic disease management: a residency-led intervention to improve outcomes in diabetic patients.
abstract: BACKGROUND
  When quality improvement processes are integrated into resident education, many opportunities are created for improved outcomes in patient care. For Bethesda Family Medicine (BFM), integrating quality improvement into resident education is paramount in fulfilling the Accreditation Council for Graduate Medical Education Practice-Based Learning and Improvement core competency requirements.
  
  
  METHODS
  A resident-developed diabetes management treatment protocol that targeted 11 evidence-based measures recommended for successful diabetes management was implemented within the BFM residency and all physician practices under its parent healthcare system. This study compares diabetes management at BFM and at 2 other family medicine practices at timepoints before and after protocol implementation. We measured hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) cholesterol, and systolic blood pressure (SBP) in adult diabetics and compared patient outcomes for these measures for the first and third quarters of 2009 and 2010.
  
  
  RESULTS
  In BFM patients, HbA1c, LDL, and SBP levels decreased, but only HbA1c improvement persisted long term. For the comparison groups, in general levels were lower than those of BFM patients but not significantly so after the first measurement period.
  
  
  CONCLUSIONS
  A resident-led treatment protocol can improve HbA1c outcomes among residents' diabetic patients. Periodic educational interventions can enhance residents' focus on diabetes management. Residents in graduate medical education can initiate treatment protocols to improve patient care in a large healthcare system.
authors.affiliation: Good Samaritan Hospital, TriHealth, Cincinnati, OH.
authors.forename: Angela N
authors.initials: AN
authors.lastname: Fellner
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Pettit
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sorscher
authors.forename: Lorraine
authors.initials: L
authors.lastname: Stephens
authors.forename: Betsy
authors.initials: B
authors.lastname: Drake
authors.forename: Richard E
authors.initials: RE
authors.lastname: Welling