Through this exploratory indicator, teams were asked to report the percentage of patients with diabetes for whom there is an individual HbA1C target recorded in the EMR. Eight teams were able to share data this time; several more indicated that they are will be in a position to do so in the next iteration of D2D. Nineteen teams shared stories about how they are approaching the recording of individualized HbA1C targets. Others indicated that while they are recording HA1C targets, they do not yet have a standardized approach and thus are unable to run a query to quantify how many patients have a recorded target.
Background: Why use individualized HBA1C targets?
Better care for patients with diabetes
Standardized HbA1C targets do not take into account the complexity and diversity of our patient populations. Even targets that vary by age may not be sufficiently flexible; for example, a frail elderly person should have a higher target than a relatively robust person, even if their age is the same. Developing individualized targets that treat patients as individuals with unique circumstances and needs allows us to ensure that we are delivering the right care to each patient. The Current Diabetes Canada Guidelines – Targets for Glycemic Control state, “Glycemic targets should be individualized based on the individual’s age, duration of diabetes, risk of severe hypoglycemia, presence or absence of cardiovascular disease and life expectancy.” See also the Canadian Journal of Diabetes (2013).
Better measurement of diabetes care
Simply put, using individualized targets allows us to count how many patients are getting the right care for diabetes, not just how many are meeting an arbitrary standard. One doctor noticed that in her own practice, only 65% of her patients met the standardized target of 0.07% HbA1C. However, when the metric was applied to individualized targets, 71% of her patients were at target. Indicators based on standardized targets fail to reflect the patients who are receiving the right care, when the right care means meeting an HbA1C level that is higher than the standardized target.
Member-Developed Tools to Get You Started
If you are a TELUS PS Suite user, consider using one of these tools developed by fellow AFHTO members.
- This Encounter Assistant has two checkboxes for HbA1C targets: A1C <0.07 or A1C 0.071-0.085. Clinicians can check off either box after discussion with the physician responsible for determining the patient’s target. The individualized target is then appended to the patient’s cumulative patient profile and visible to all care providers. It was developed by Denis Tsang, RD at CareFirst FHT and is available for download from the Telus PS Community Portal.
- This custom form allows you to customize HbA1c targets for patients with diabetes. It captures the target HbA1c and indicates whether the patient is meeting the target. The clinician is also able to change the target for each patient. It was developed Dr. Kevin Samson, Physician and IT Lead; Hope Latam, former QIDS Specialist; and Joel Wilson, current QIDS Specialist at East Wellington FHT. and is available for download on the Telus PS Community Portal.
D2D 5.0: Emerging Approaches to Recording HbA1C Targets
Several teams have been working on tools to enable the recording and tracking of individualized HbA1C in their EMRs. Some of these are available for use now, and others are still in testing. Here are the approaches they’ve told us about:
- Flow sheets and custom forms that include checkboxes or free-text fields.
- Encounter assistants such as this one.
- Patient profiles in TELUS PS EMR.
- In the case of one small team, a spreadsheet maintained by the diabetes nurse.
| Recording Individualized HbA1C Targets in the EMR | |
| What makes it easy? | What makes it difficult? |
| Flow sheets and custom forms. | Forms that don’t distinguish between default HbA1C targets and individualized ones that happen to be the same as the defualt. |
| Encounter assistants. | Flow sheets and custom forms that don’t yet include a field for individualized HbA1C Target. |
| Other EMR tools, such as patient profiles. | Move to a new EMR. |
| Having a diabetes team who works with physicians to review diabetes care and ensure that patients’ targets are recorded. | Uncertainty as to the most effective way to document this information. |
Click the image below to download an interactive graph of D2D data for Recorded HbA1C Target. This will allow you to hover over the individual bars and see the stories that each team provided about how they recorded individualized HbA1C targets in the EMR. 
NOTE: This will not work in all web browsers; if you cannot see the stories, download (save) the PDF and open it in a PDF viewer, such as the Adobe Acrobat Viewer for full functionality. If you have any problems please contact us.
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