Error loading player: No playable sources found

P018

Optimizing Diabetes Management in Primary Care


Erie County Medical Center (ECMC) in Buffalo, NY, serves as the largest safety net hospital in the region, caring for a high-risk population disproportionately affected by healthcare disparities tied to socioeconomic status and racial/ethnic backgrounds. These disparities contribute to poor outcomes in chronic conditions like diabetes. Erie County has higher diabetes-related hospitalization and mortality rates than the rest of New York State, underscoring the urgency of effective diabetes control.
The primary objective of this project (optimizing diabetes management in primary care) was to develop and implement a comprehensive diabetes management protocol to enhance patient outcomes and streamline care delivery. This initiative sought to address transportation challenges, improve patient awareness, and promote adherence and self-management behaviors. By tailoring interventions—including lifestyle modifications, medication counseling, education, outreach, and care coordination—to each patient’s unique needs, the project actively addressed social determinants of health (SDOH), such as health literacy and transportation barriers, within a team-based care model.
Between 2021 and 2024, ECMC’s targeted intervention program, developed and led by an RN, significantly improved diabetes management outcomes. The proportion of patients achieving glycemic control rose from 49.9% to 66.8%, reflecting a 33.87% improvement. The average A1C among primary care patients decreased to 7.3. Evidence-based strategies, including personalized education, regular monitoring, and team-based care delivery drove these improvements.
This project demonstrates the transformative potential of addressing SDOH and disparities through structured evidence-based protocols. It highlights the critical role of innovative nursing practices in improving diabetes outcomes and advancing health equity in underserved populations.
Learning outcome: By the end of this poster session, attendees will be able to identify evidence-based strategies for improving diabetes management in underserved populations, recognize the impact of addressing social determinants of health on patient outcomes, and apply a team-based care model to enhance adherence and self-management behaviors in their own practice.

Learning Objective

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Speaker

Speaker Image for Amanda Farrell
Amanda Farrell, MSN, RN, AMB-BC

Related Products

Thumbnail for Pediatric SIG
Pediatric SIG
Contact hours available until 5/14/19…
Thumbnail for Use of the Project ECHO Model to Support Frontline Nurses in Complex Care Management in a Multi-Site Federally Qualified Health Center: HRSA-Funded Project
Use of the Project ECHO Model to Support Frontline Nurses in Complex Care Management in a Multi-Site Federally Qualified Health Center: HRSA-Funded Project
Discuss how Community Health Center, Inc. (CHCI), a multi-site, federally qualified health center in Connecticut, has translated the Project ECHO model to provide primary care nurses with ongoing support as they build their capacity to manage complex patients…
Thumbnail for Integrating Ambulatory Care Rapid Fire Sessions
Integrating Ambulatory Care Rapid Fire Sessions
In these short rapid-fire presentations, multiple speakers highlight novel approaches to integrating ambulatory care in BSN curricula and clinical experiences…
Thumbnail for Schedule a Video at Every Discharge (SaVED)
Schedule a Video at Every Discharge (SaVED)
Purpose: The Veteran Health Administration established the two-day post-discharge contact ratio in 2010, with a national goal of 75% to improve care transitions, facilitate optimal health outcomes, and reduce readmission rates…
Privacy Policy Update: We value your privacy and want you to understand how your information is being used. To make sure you have current and accurate information about this sites privacy practices please visit the privacy center by clicking here.