Date of Award

Spring 5-7-2021

Document Type

DNP Project

Project Team Faculty Member

Dr. Annie Imboden

Project Team Faculty Member

Dr. Terri Furfaro

Project Team Faculty Member

Dr. Jackie Clement


hyperglycemia, endocrinology, referral, diabetes management, ICD-10 codes, hemoglobin A1C


Diabetes mellitus and prediabetes affect 34 million and 88 million Americans, respectively. The early detection and management of elevated blood glucose levels is fundamental to preventing comorbid complications. While other countries have published referral guidelines, the United States is lacking in practice standards. At a central Illinois healthcare institution, the diagnosis code for elevated blood glucose (R73) was noted at a higher rate than endocrinology referrals. The purpose of this retrospective investigation was to explore the root causes of this disproportion through deidentified patient data. The average number of wait days for an endocrinology appointment was investigated and found to be 90 days. The prevalence of R73 codes in family and internal medicine, along with their referral rates to endocrinology were evaluated. There was inconsistency of diagnosis codes, referral rates, and ages of patients between departments, as well as incomplete referrals. Based on the gathered data, evidence-based solutions were identified to improve the referral process to endocrinology. There are numerous implications for future practice: (a) to improve availability and reduce wait times, a cost-benefit analysis can be conducted to determine the benefit of an additional endocrinology provider; (b) to expedite endocrinology referrals, a process analysis can be conducted to address delays, and (c) an algorithm can be created to target at-risk populations to standardize R73 coding and referrals. Long-term implications of these interventions will be improved treatment and reduced morbidity and mortality in this patient population.

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