DIA-BEATERS At Westminster Medical Clinic


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DIA-BEATERS At Westminster Medical Clinic

  1. 1. DIA-BEATERS At Westminster Medical Clinic
  2. 2. Background <ul><li>Westminster Medical Clinic and WestMed Family Healthcare </li></ul><ul><li>Westminster, CO </li></ul><ul><li>Suburban private practices </li></ul><ul><li>3 physicians and 1 physician assistant at WMC </li></ul><ul><li>170 diabetic patients </li></ul><ul><li>3 physicians and 1 physician assistant at WFHC </li></ul><ul><li>114 diabetic patients </li></ul>
  3. 3. AIM Statement <ul><li>To empower the patient in their management of diabetes. Through education and patient responsibility, help set self-management goals that are meaningful and doable. Follow and translate evidence-based guidelines into clinical practice. </li></ul>
  4. 4. Diabeaters <ul><li>Senior Leader – Barb Burrowes, PA-C </li></ul><ul><li>Clinical Champion– Scott Hammond, M.D. </li></ul><ul><li>Day-to-day leader– Jan Vergo, R.N. </li></ul><ul><li>Front office leader – Angela Groth </li></ul>
  5. 5. Selected Measures at WMC <ul><li>HgA1c < 7 in 65% of patients </li></ul><ul><ul><li>(54% achieved) </li></ul></ul><ul><li>HgA1c < 8 in 85% of patients </li></ul><ul><ul><li>(83% achieved) </li></ul></ul><ul><li>BP <130/80 in 50% of patients </li></ul><ul><ul><li>(49% achieved) </li></ul></ul><ul><li>BP <140/90 in 75% of patients </li></ul><ul><ul><li>(83% achieved) </li></ul></ul>
  6. 6. Selected Measures at WMC <ul><li>LDL cholesterol < 100 in 65% of patients </li></ul><ul><ul><li>(60% achieved) </li></ul></ul><ul><li>Retinal exams < 1 year in 70% of patients </li></ul><ul><ul><li>(78% achieved) </li></ul></ul><ul><li>Self management goals in 60% of patients </li></ul><ul><ul><li>(69% achieved) </li></ul></ul>
  7. 7. Changes Tested <ul><li>Clinical Information Support </li></ul><ul><li>Decision Support </li></ul><ul><li>Health System Organization </li></ul><ul><li>Delivery System Design </li></ul><ul><li>Self-Management Support </li></ul>
  8. 8. Self-Management Support <ul><li>Currently Testing: </li></ul><ul><li>Patient satisfaction survey </li></ul><ul><li>Implemented into our Delivery System: </li></ul><ul><li>Patient education tools </li></ul><ul><li>Implemented Diabetes University program to test patient competency </li></ul><ul><li>Utilization of exercise log </li></ul>
  9. 9. Community Resources <ul><li>Currently Testing: </li></ul><ul><li>none </li></ul><ul><li>Implemented into our Delivery System: </li></ul><ul><li>Obtained list of available local resources </li></ul><ul><li>Use local Recreational Center catalogs to facilitate lifestyle changes </li></ul><ul><li>Collaboration with PHP (local IPA) </li></ul>
  10. 10. Health System Organization <ul><li>Currently Testing: </li></ul><ul><li>none </li></ul><ul><li>Implemented into our Delivery System: </li></ul><ul><li>Diabetes care team roles and responsibilities defined </li></ul><ul><li>Monthly team meetings </li></ul><ul><li>Weekly administrative meetings </li></ul>
  11. 11. Decision Support <ul><li>Currently Testing: </li></ul><ul><li>Use of Impedance cardiography to improve BP control </li></ul><ul><li>Implemented into our Delivery System: </li></ul><ul><li>Adoption CFHC guidelines </li></ul><ul><li>Provider education on standards of diabetic care </li></ul><ul><li>Patients informed and given results of guidelines pertinent to their care </li></ul>
  12. 12. Clinical Information System <ul><li>Currently Testing: </li></ul><ul><li>none </li></ul><ul><li>Implemented into our Delivery System: </li></ul><ul><li>Customized CDEMS registry </li></ul><ul><li>Immunization and Eye care recall and tickler system </li></ul><ul><li>Database interface with Quest Labs </li></ul><ul><li>Patient subgroups identified for proactive care </li></ul><ul><li>Weekly feedback of pertinent measures to providers </li></ul>
  13. 13. Delivery System Design <ul><li>Currently Testing: </li></ul><ul><li>Patient interest in group visits </li></ul><ul><li>Implemented into our Delivery System: </li></ul><ul><li>Started weight loss and exercise group visits for staff members </li></ul><ul><li>Scheduled 1 st group visit for diabetic patients in July 2005 </li></ul><ul><li>Physician Assistant as Diabetes Educator </li></ul><ul><li>Increased appointment time for individual patient visits </li></ul><ul><li>Streamlined documentation and charting </li></ul><ul><li>Increased provider efficiency utilizing planned visits </li></ul><ul><li>Tickler system implemented to assure follow-up </li></ul>
  14. 14. Results % of patients at goal
  15. 15. Summary <ul><li>Challenges to date </li></ul><ul><li>“ Getting patients in” at recommended intervals (scheduling, copays) </li></ul><ul><li>Changing behaviors of patients and providers </li></ul><ul><li>Maintaining enthusiasm </li></ul>
  16. 16. Successes <ul><li>Integrated chronic care paradigm into a private practice and introduced concept to healthcare providers </li></ul><ul><li>Developed a workable and sustainable infrastructure </li></ul><ul><li>Regular feedback to providers on targeted measures </li></ul><ul><li>Utilization of registry for proactive care </li></ul><ul><li>Developed educational tools to empower patients to self-management and to test their competency </li></ul><ul><li>Streamlined data entry and documentation to increase provider efficiency </li></ul><ul><li>Enabled more time for office visits </li></ul><ul><li>Markedly improved immunization status and eye care with modest improvement in lipid and BP control </li></ul>
  17. 17. Next Steps <ul><li>Reach all goals by March 2006 </li></ul><ul><li>Continue development of group visits </li></ul><ul><li>Establish same model at our other facility </li></ul><ul><li>Expand to other chronic care clinics such as COPD, HTN </li></ul><ul><li>Add wireless capability to access data at each provider work station </li></ul>