Twelve health organizations from around the US were selected to participate in a chart review Hypertension and Diabetes Initiative with the goal of improving blood pressure control in persons with diabetes.

Hypothesis:

A three-phase quality improvement initiative facilitated and monitored through the International Diabetes Center (IDC) will result in improved population-mean systolic blood pressure in the aggregate data pool of patients from all 12 participating sites at geographically distinct health systems.

Phase 1 - Preparation: Each participating site begins to organize itself for the project. Baseline data will be collected and will be used to benchmark where each site is relative to blood pressure control/management of persons with diabetes prior to the implementation of the training programs.

Phase 2 - Implementation: Sites begin to address the gaps they have identified that affect blood pressure outcomes of patients with diabetes. IDC provides two on-site training programs for providers and support staff.

Phase 3 - Follow-up: IDC provides on-going support to each site via individual and collaborative conference calls and resources on the project Web site. Patient and visit data (audit form) will be collected six and 12 months after training. This data will be compared to the site's pre-training data.

Inclusion Criteria:

• ICD-9 Code 250 (indicates type 1 or type 2 diabetes)
• ICD- Code 648.0 (indicates pregnancy with type 1 or type 2 diabetes)
• ICD-9 Code 357.2 or 362.0, indicating complications of diabetes.
• A prescription for insulin or oral hypoglycemic agents
• Include those 18-75 years

Exclusion Criteria:

• Attend a dialysis unit (if the nephrologist is primary care manager)
• Have gestational diabetes (ICD-9 Code 648.8)
• Have a terminal illness (e.g., hospice patient)
• Do not have a documented blood pressure within the past year (this is asked on the audit form)

Primary care clinic