SUN-854 - Areas of Opportunity in Diabetes Care Delivery: Perspectives from Our Hispanic/Latino Patients

Background: Healthcare Effectiveness Data and Information Set metrics used to assess quality of care defines poorly controlled diabetes as a glycemic status of hemoglobin A1c >9%, which is associated with microvascular and macrovascular complications. Our large academic medical center cares for more than 39,000 patients with diabetes in primary care and endocrinology. 12% of Hispanic/Latino patients in our health system have A1c levels >9%, which is a disproportionately higher prevalence compared to 6% among other groups.

Objective: To utilize the Patient Voice toolkit to identify opportunity areas for improved glycemic control and care delivery among the Hispanic/Latino patient population.

Methods: An interview guide was created based on literature review and feedback from subject matter experts providing care for diabetes patients. Patients were included if they self-identified as Hispanic/Latino, had a diagnosis of diabetes, and had established with a primary care provider or endocrinologist. Interviews were recorded and stored on a secure server. Transcription data was coded and organized into themes and subthemes through an iterative two-reviewer process.

Results: Twenty semi-structured interviews were conducted with patients in their preferred language. Five opportunity areas were identified.
1. Culturally competent care: five patients expressed interest in culturally competent care, particularly for nutrition education on traditional foods. Of the 11 patients who identified Spanish as their primary language, six expressed a preference for Spanish-speaking providers or noted language concordance to be beneficial to their care.
2. Diabetes education: nine patients were interested in a diabetes educator or nutritionist. Three patients were interested in more educational materials from the health system, including brochures and videos.
3. Diabetes distress: 10 patients expressed feelings of diabetes distress, particularly around lifestyle management and medications. Two patients were interested in group classes for social support, and one patient was interested in stress management classes for diabetes.
4. Diabetes technology: of the 10 patients using insulin, six did not have continuous glucose monitors. Two patients had misconceptions about them, and one was never offered one.
5. Healthcare access: four patients experienced long wait times to see specialists or diabetes educators and identified this as an area for improvement.

Conclusion: Through patient-facing interviews, our quality improvement team engaged patients to identify areas of improving care delivery important to them. Future quality improvement work will focus on improving culturally competent nutrition education, offering classes on lifestyle management and diabetes distress, increasing guideline-directed usage of diabetes technology, improving access to diabetes providers.

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