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By answering questions below about your practice site, current clinical approaches to diabetes, and challenges you face, you will be better able to develop and implement a relevant QI activity. 

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* 1. Your profession/role in the practice:

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* 2. Practice address (city):

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* 3. Practice address (state):

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* 4. Practice address (zip code): 

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* 5. Practice type. Check all that apply:

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* 6. Number of health care providers at your practice location:

  None 1 to 2 3 to 5 6 to 10 More than 10
Physicians
Residents
Physician assistants
Nurse practitioners
Nurses
Pharmacists
Medical assistants
LPNs
Practice managers
Front desk staff/receptionists
Social workers
Patient navigators
Behavioral healthcare provider
Diabetes educators

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* 7. Practice setting:

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* 8. Estimated number of patients at practice site annually (panel size):

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* 9. How does your practice approach community engagement? Check all that apply: 

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* 10. Indicate the quality improvement experience of your practice's staff:

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* 11. What quality improvement (QI) resources does your practice have? Check all that apply: 

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* 12. What priorities for quality improvement, in general, does your practice have? Check up to three:

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* 13. What barriers, if any, does your practice face with QI activities? Check all that apply: 

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* 14. Estimated patient demographics:

  Greater than 50% 25 to 50% 10 to 25% Less than 10%
White, non-Hispanic
African American or Black
Hispanic or Latino
Asian
American Indian/Native American
Native Hawaiian/Pacific Islander
Medicare recipient
Medicaid recipient
Uninsured
Primary language is English

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* 15. How often does your practice perform the following in managing your diabetes patient population?

  Rarely Sometimes Often Routinely
Assess social determinants of health, such as food insecurity, housing instability, and financial barriers.
Refer patients to local community resources.
Provide patients with self-management support and training.
Use a shared decision-making approach to developing individual treatment plans.
Use motivational interviewing techniques to enhance patient engagement, adherence, and outcomes.
Employ the services of a diabetes educator.
Make sure your patients are up-to-date on all recommended immunizations.
Provide or access patient navigation services for lung cancer screening.
Give influenza immunizations in your practice.
Use your EHR to identify and track patients eligible for lunch cancer screening.
Assess and track co-morbid heart failure.
Assess and track co-morbid chronic kidney disease.
Monitor and manage blood pressure.
Monitor and manage A1C.
Monitor and manage lipids.
Monitor and manage co-morbid depression.
Monitor medication adherence.
Monitor emergency department utilization.
Monitor and manage obesity.
Monitor and manage tobacco use.
Follow the ADA standards for Diabetes Care in determining glycemic treatment.
Assist patients in gaining affordable medications.
Assist patients in getting CGMs.
Use telehealth for patient appointments and education.

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* 16. What barriers to diabetes management does your practice face?

  Check all that apply. Check top two. 
Patient adherence.
Costs of medications for patients.
Providing or accessing patient education.
Lack of time per patient visit.
COVID-19 impact.
Meeting patient social needs such as transportation, healthy food access, etc.
Patient health literacy and numeracy.
Use of insulin.

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* 17. What support would you like to enhance your diabetes care and outcomes?

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* 18. If you would like to talk with someone at NMQF's SHC about diabetes education and community engagement, please provide your name, email address, and name of your practice below.

0 of 18 answered
 

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