Shaun Cole QI project


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Shaun Cole QI project

  1. 1. Quality Measures in Diabetics QIP Project Shaun Cole, M.D., M.P.H Patrick Smithedajkul, M.D.
  2. 2. Problem Statement • Successful diabetes management can be assessed using markers of target processes, such as Hb A1c, LDL and blood pressure. • Diabetic patients are not meeting quality goals in the Baldwin PCIM clinic.
  3. 3. Root Cause Analysis
  4. 4. Magnitude •Among US residents >65 years, 26.9% had DM in 2010 •Leading cause of kidney failure, NT lower-limb amputations and new cases of adult blindness in the US •Major cause of heart disease and stroke •7th leading cause of death in the US •PCIM chart review - pending
  5. 5. Magnitude • $174 billion:Total costs of diagnosed diabetes in the United States in 2007 • $116 billion for direct medical costs • $58 billion for indirect costs (disability, work loss, premature mortality)
  6. 6. Magnitude • Quality measures (LDL, blood pressure, Hgb A1C) • What percentage of our diabetic patient’s have goal metrics in all three? • Answer: 20.3% • What percentage of the consultant’s diabetic patients? • Answer: 30.2%
  7. 7. Why Should We Care? • For every 1% decrease in HbA1c, the chances of blindness, amputations and renal disease decreases by 35% (Level A) • Reduction of LDL below 100 and systolic BP les than 130 reduced CVD 40-50% (Level A) • ADA clinical practice guidelines can be found at
  8. 8. Stakeholders • Consultants • Residents • Diabetic Care Managers • Nursing staff • Patients
  9. 9. Potential Interventions • Resident Education to increase clinical guidelines awareness • Quarterly reports of patients’ metrics • One-on-one time with diabetic care managers to discuss critical gaps in management and patient approach
  10. 10. Costs/Benefits • Minimal costs • Diabetic care managers already present • Amalga Database present • May take months to see benefit • Potential risks- minimal • Potential benefits- reduction in morbidity and mortality, better relationships, save money in healthcare, foster team-building in the workplace
  11. 11. Methods and Assessment • Prospective cohort • Between 4 firms, two will receive quarterly reports and visits with care managers (intervention arm) and two will receive “as needed” care manager time and reports • Each quarter, quality metrics will be assessed • Allows for both longitudinal progress of interventional arms as well as direct comparative assessments to control arms
  12. 12. Methods and Assessment • DM care manager time measurements • compared between two cohorts • Resident satisfaction • assessed at the end of the intervention period using a 4- point Likert scale • DM Care manager satisfaction • single focus group conducted at the end of 1 year
  13. 13. References • Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. • Agency for Healthcare Research and Quality • American Association of Diabetes Educators • American Diabetes Association