Cole qip


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Cole qip

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