Improving diabetes self-management education and support referrals in primary care through a standardized referral workflow: A quality improvement initiative

Background: Diabetes Mellitus affects more than 38 million Americans and is associated with significant morbidity, mortality, and healthcare expenditures. Despite strong evidence supporting Diabetes Self-Management Education and Support (DSMES) as an essential component of comprehensive diabetes care, utilization remains low. DSMES participation has been associated with improved glycemic control, reductions in diabetes-related complications, enhanced self-management behaviors, and decreased healthcare utilization. National organizations, including the American Diabetes Association (ADA), Centers for Disease Control and Prevention (CDC), and the Association of Diabetes Care & Education Specialists (ADCES), recommend DSMES at diagnosis, annually, when treatment goals are not met, when complications develop, and during transitions in care. However, fewer than half of individuals with diabetes receive DSMES, and participation rates remain particularly low in primary care settings. Evidence suggests that inconsistent referral practices, lack of standardized workflows, and limited provider awareness contribute significantly to underutilization.

Purpose: The purpose of this quality improvement project is to increase DSMES referrals for adults with poorly controlled Diabetes Mellitus in primary care through implementation of a standardized, evidence-based referral workflow integrated into existing clinical processes.

Methods: This 12-week quality improvement initiative will be implemented at two rural primary care clinics in Minnesota. The intervention combines three evidence-based strategies: Workflow standardization, provider education, and patient engagement. Providers and nursing staff will receive education on DSMES benefits, ADA-recommended referral checkpoints, and utilization of a standardized referral algorithm. During pre-visit planning, registered nurses will identify eligible patients and initiate a structured referral workflow. Providers will discuss DSMES as a routine component of diabetes management, provide targeted education regarding program benefits, and distribute patient education materials. Following review of updated HbA1c results, providers will determine DSMES recommendations using the referral algorithm. Registered nurses will then reinforce education, assess readiness to participate, facilitate referrals within the electronic health record, and document barriers to participation when referrals are declined. Primary outcomes include changes in DSMES referral rates and adherence to the referral workflow. Secondary measures include provider participation in DSMES education, patient education delivery, provider perceptions of workflow feasibility and sustainability, and identification of barriers to DSMES participation.

Results/Outcomes: Attendees will gain practical knowledge regarding implementation of a standardized DSMES referral process within primary care settings. The presentation will highlight strategies for integrating evidence-based referral practices into existing workflows, improving interdisciplinary collaboration, and addressing common barriers to DSMES utilization. Participants will receive adaptable tools and implementation strategies that can be translated to a variety of outpatient and community-based settings. Learning outcomes will be evaluated through participant feedback, audience discussion, and self-assessment of confidence in applying workflow-based quality improvement strategies.

Conclusions: DSMES remains one of the most effective yet underutilized interventions in diabetes care. Standardized referral workflows offer a practical and scalable approach to improving DSMES access and utilization by reducing variability in referral practices and embedding evidence-based recommendations into routine care delivery. Broader implementation of similar workflow-driven interventions may increase participation in DSMES, strengthen patient self-management, improve glycemic outcomes, reduce diabetes-related complications, and support healthcare organizations in achieving population health and quality improvement goals. This project demonstrates how primary care teams can operationalize national diabetes care recommendations through sustainable systems-level change.

Jordan Gagnon BSN, RN is a Doctor of Nursing Practice–Family Nurse Practitioner (DNP-FNP) student at Creighton University and a Registered Nurse with Accent Care Home Hospice in Minnesota. Jordan has clinical background includes experience in critical care, primary care, and chronic disease management across a variety of healthcare settings. Jordan pleased to submit abstract, Improving Diabetes Self-Management Education and Support Referrals in Primary Care Through a Standardized Referral Workflow. This quality improvement project addresses a significant gap in diabetes care by implementing evidence-based strategies to increase referrals to Diabetes Self-Management Education and Support (DSMES), a proven intervention associated with improved glycemic control, reduced complications, and enhanced patient self-management. Jordan believe this presentation would be valuable to conference attendees because it offers practical, scalable strategies that can be adapted across diverse healthcare settings to improve diabetes outcomes. By sharing lessons learned from implementing a standardized referral process, provider education, and patient engagement interventions, this presentation aims to support clinicians and healthcare leaders in translating evidence-based recommendations into sustainable practice improvements. Thank you for your consideration. Jordan has appreciate the opportunity to contribute to the conference and advance discussions surrounding innovative approaches to diabetes care. Sincerely, Jordan Gagnon BSN, RN Doctor of Nursing Practice–Family Nurse Practitioner Student Creighton University.