Evaluation of Provider Documentation Patterns as a Tool to Deliver Ongoing Patient-Centered Diabetes Education and Support

Diabetes is one of the most common chronic diseases in the world. As a disease with long term complications requiring changes in management, it requires ongoing diabetes self-management education and support (DSME/S). In the United States, however, only a small proportion of people with diabetes receive DSME/S. The diabetes education that providers deliver during follow up visits may be an important source for DSME/S. We collected 200 clinic notes for 100 adults with diabetes and studied the History of Present Illness (HPI) and Impression and Plan (I&P) sections. Using a codebook based on the seven principles of American Association of Diabetes Educators Self-Care Behaviors (AADE7), we conducted a multi-step deductive thematic analysis to determine the patterns of DSME/S information occurrence in clinic notes. We used the Generalized Linear Mixed Models for investigating whether providers delivered DSME/S to people with diabetes based on patient characteristics. During follow up visits, Monitoring was the most common self-care behavior mentioned in both HPI and I&P sections. Being Active was the least common self-care behavior mentioned in HPI section and Healthy Coping was the least common self-care behavior mentioned in I&P section. Generally, providers delivered DSME/S to people with diabetes regardless of patient characteristics. The results may indicate a lack of patient-centered education when people with diabetes visit providers for ongoing management. Further studies are needed to identify the underlying reasons why providers have difficulty delivering patient-centered education.