2050-P: Improving Documentation of Comprehensive Foot Examinations in a Rural Endocrinology Clinic: A Quality Improvement Initiative

Introduction and Objective: Diabetes-related foot complications are a leading cause of morbidity and mortality. Although the ADA recommends annual comprehensive foot examinations for all adults with diabetes, 28-73% of people do not receive them, and 84-100% of foot examinations are not documented in EHRs. We aimed to increase documentation of foot examinations for adults with type 2 diabetes through staff education, visual reminders, and workflow redesign. Methods: Using the Model for Improvement, the team employed Plan-Do-Study-Act (PDSA) methodology for process improvement. On October 16, 2024, all clinic staff received education on foot exam documentation. On October 23, 2024, visual prompts were placed in exam rooms. On November 12, 2024, we ran a small-scale test of a medical assistant workflow to pre-populate the health maintenance order. Data were reviewed bimonthly using statistical process control charts to identify shifts and special cause variation. Results: Over the 12-month intervention period, EHR documentation of annual foot examinations increased from a mean of 49% to 67% (n=10,065; see Figure 1). Conclusion: Education and visual prompts increased EHR documentation of foot examinations. Small-scale testing refined workflow issues before full implementation. Sustainability will depend on ongoing training, continued staff engagement, regular audit and feedback, and embedded visual prompts in clinical workflows. Disclosure A. Healy: Consultant; Ended; Novo Nordisk. Speaker's Bureau; Current; Sanofi. M.L. Cottrill: None. L.J. Lammert: None. S.E. Adkins: None. S. Miller-Branam: None. E.A. Beverly: None. Funding Ohio Department of Medicaid Grant (G-2627-05-0009/ODM202619)