1. Chronic Disease Study: Raising the Quality of Healthcare Among the Diabetic Population
Sania S. Joshua
Graduate student, Master of Public Health (M.P.H.), Oakland University
Practicum Preceptor: Sarah Decaussin, CPC
Wayne State University Physicians Group: Quality Management & Patient Safety Division
I was working on a diabetes study at Wayne State University Physicians Group (WSUPG) from
May 05, 2014 to August 12, 2014. WSUPG is the second largest nonprofit multi-specialty
physicians’ organization in southeast Michigan. The project that was entrusted to me at WSUPG
essentially entails a system of monitoring and evaluation of the nature of a chronic disease such
as diabetes, and how it affects the diabetic population.
 Purpose: To identify quality gaps in ongoing healthcare among the diabetic patients seen at
WSUPG.
 Goal: To ameliorate the quality of chronic disease care.
 Objective: To utilize data analysis, and initiate resolutions and clinical outreach by August 12,
2014.
The diabetic population study conducted at WSUPG aimed to fulfill the following
competencies in the field of public health:
Discipline-specific competencies:
 Social and Behavioral Sciences: To identify behavioral disciplinary models that can be used
in population studies, research and clinical practices pertaining to diabetes, and to describe
the role of community factors in the solution of public health problems.
 Health Management and Policy: To communicate policy process for improvement in
healthcare, and address organizational performance issues using appropriate channels and
technologies, in order to elevate the quality of health status of populations.
Interdisciplinary/Cross-cutting competencies:
 Professionalism: To apply scientific knowledge for critical evaluation and decision-making in
public health issues and embrace the collaborative efforts of diverse constituencies, which
would positively impact professional practices in a clinical setting.
 Program Planning: To differentiate goals, objectives, activities, and expected outcomes in a
proposed plan of action, public health program or intervention.
 Leadership: To demonstrate management skills and collaborative approaches that would
help achieve both organizational and community health goals.
 Diversity and Culture: To empower diverse communities, and develop strategies and plans
in accordance to cultural values and traditions of the community being served.
Upon accepting the invitation from WSUPG to conduct the diabetic population study, I primarily
plan to achieve an optimal learning of the mechanisms of chronic disease care. Moreover, I
expect to gain such knowledge from a corporate-clinic perspective. In order to accomplish this
purpose, I have set the following goals as I proceed to conduct the diabetes study at WSUPG:
 To satisfy the discipline-specific and cross-cutting competencies of public health as stated in
the above section.
 To receive an understanding of factors that can mitigate those issues that affect the quality of
ongoing clinical care for diabetes.
 To impact the quality of diabetic patient reporting system at WSUPG and develop strategies
for organizational performance improvement.
 To provide resolutions for any data discrepancies or care gaps that may exist in the clinical
setting at WSUPG, which might be affecting the overall quality and management of services
pertaining to diabetic healthcare.
 To develop a plan of action and/or intervention in potential areas of improvement of clinical
practices at WSUPG, which will be based upon scientific literature and evidence-based
research.
 To conduct clinical and/or educational outreach based on identified priorities and evidence-
based practices, by July 2014.
 To follow potential courses of action in accordance to one of the overarching goals of
Healthy People 2020  “attain high-quality, longer lives free of preventable disease,
disability, injury, and premature death.”
INTRODUCTION
PRACTICUM PLAN
May 2014: Chart Audit / Data Collection
 Social and Behavioral Sciences:
 Utilized the Theory of Reasoned Action (TRA) model to assist in research pertaining to the
behavior of individuals with chronic diseases. The given study sample consisted of 98
diabetic patients. Electronic Medical Records (EMR)/patient reports were used to identify
data related to specific measures that was unable to be reported on.
June 2014: Data analysis
 Social and Behavioral Sciences:
 Identified data gaps in diabetic patient reports as it might affect physicians’ behavior
and response in terms of an ongoing care for a diabetic patient.
 Health Management and Policy:
 Utilized EMR that was retrieved from the Healthcare Information System technology
called NextGen, and applied performance improvement tools such as Health
Effectiveness Data and Information Set (HEDIS) to address organizational issues.
 Concluded data analysis and identified the priority area of focus for next action, which
was the need for the given population to be scheduled for diabetic eye exams.
July 2014: Clinical Outreach and Plan of Action (POA)
 Health Management and Policy:
 Discussed policy measures with clinical directors and representatives of various
healthcare divisions, regarding employing measures to increase ophthalmology
evaluations for the diabetic patients at WSUPG.
 Leadership:
 Attended executive meetings and participated in active discussions with colleagues
that would drive potential courses of action for improvement in healthcare status.
 Achieved refinement of skills to successfully manage multiple tasks and strict
deadlines.
 Professionalism:
 Stressed on the importance of collaboration with leading pharmaceutical companies
such as Sanofi U.S., which would lead to performance improvement, and positively
impact the clinical/professional practices at WSUPG.
 Collaborated with Kresge Eye Institute (KEI), to activate the scheduling of
ophthalmology exams for diabetic patients seen at WSUPG clinical facility in Detroit.
 Program Planning:
 Set measurable objectives that would activate the “Calling Campaign,” which was the
proposed POA, in order to ensure that the diabetic patients seen at WSUPG clinic in
Detroit will have an ophthalmology evaluation scheduled by the end of June 2014.
 Generated Plan-Do-Check-Act (PDCA), the four-step management tool for the purpose
of initiating and implementing the “Calling Campaign.”
 Developed patient education tools such as a patient-provider pre-scheduling form for
diabetic eye exam and diabetic eye exam flyers.
 Diversity and Culture:
 Initiated the “Calling Campaign,” a population-centered approach, for advancing the
quality of healthcare provided to individuals residing in Detroit and are affected by
diabetes.
 The “Calling Campaign” adhered to a cost-efficient plan that accommodated the
socioeconomic status of the Detroit community. Likewise, the logistics of the proposed
POA practiced cultural-sensitivity to the highest degree in regards to this community.
1 2
1
6 7
19
27
34
4
PRACTICUM ACTIVITIES
44
males
54
females
Gender distribution Age distribution
August 2014: POA Implementation and Executive Presentation
 Leadership:
 Utilized the opportunity to run “Expectations Huddle,” a monthly meeting held in the
Quality Management and Patient Safety Division of WSUPG, in collaboration with
my colleagues of the Master of Public Health Program.
 Presented an executive summary of the diabetic population study and disseminated
findings to an audience consisting of approximately 50 medical
residents/physicians, medical school faculty and executives, at the School of
Medicine in Wayne State University.
The diabetic population study executed at WSUPG met with the following two challenges:
1. Chart Review: Recommended areas of focus were identified based on data discrepancies
located from the processes of reviewing and auditing EMR and patient charts. Hence, this
study did not conduct a detailed root cause analysis (RCA). For future purposes, the RCA
may help in validating the data observations further.
2. Time: The time-frame utilized for the diabetes study at WSUPG entailed a period of 180
hours. An in-depth study may have located more contributing factors in light of the
decreased rate of diabetic patient participation in ophthalmology exams. However, such a
method of study may consume a time frame of approximately two years. Hence, the time
allotted to conduct the diabetes study during the practicum period may have been
constricting in terms of producing comprehensive analytical reports for the given population
sample.
 Overall, the practicum period spent at WSUPG from May 2014 to August 2014 has certainly
enhanced my knowledge in regards to improving the quality of healthcare in light of chronic
diseases.
 The diabetes study executed at WSUPG recognizes that ophthalmology evaluations are
significant in ongoing clinical care pertaining to diabetes, and that the timely execution of
eye exams play an important role in the improvement of the healthcare status among the
diabetic population.
 This study concluded that 68% of diabetic patients in the study sample are in need of an
ophthalmology evaluation as of August 2014. Following the implementation of the ‘Calling
Campaign,” approximately 50% of the given population sample have a diabetic eye exam
scheduled as of August 12, 2014.
 The PDCA will ensure further collaboration with healthcare providers and care teams at
designated primary care physician (PCP) locations to continue the POA process as data
becomes available and to sustain the calling campaign.
 Finally, understanding the corporate and administrative elements of healthcare has certainly
assisted the advancement of my roles as a current MPH student and a future public health
practitioner. Thus, the practicum period spent at WSUPG has further ignited my passion and
interest in regards to chronic disease population studies, with particular focus on diabetes
mellitus.
 Takeaways / Valuable Lessons Learned:
 Make strategic use of time by managing, delegating, seeking assistance and pushing back;
however, pushing back should be the last option if the first three fail to be plausible.
 Gain trust by meeting expectations and adhering to weekly goals/agendas/deadlines.
 A true professional would adapt and be prepared for both informal and formal style of
communication with colleagues and business partners.
 A professional lifestyle consists of a great deal of respect for others and being mindful of
various cultural contexts and diversities.
 “Don’t wait for the moment. Take the moment and make it perfect.”
 Oakland University – Department of Master of Public Health
 Donna Saxton, MHA, MPH, FACHE, CPHQ
 Sarah Decaussin, CPC
 Maribeth Mateo, MD
 Michelle Bryant, MBA, BSN, RN, CPHQ
 Jawad Niazi
PRACTICUM ACTIVITIES (continued)
CHALLENGES
CONCLUSIONS
ACKNOWLEDGEMENTS