Improving Diabetes Care

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Improving Diabetes Care
Thomas Hei, MD, FAAFP
Washington State Collaborative Learning Session
3 September 11-12, 2006
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UW Medicine - Auburn Clinic

• 4 Family Physicians 3 PAs
• Established in 1998
• 8 King County Neighborhood Clinics
• Pilot Population 270 patients gt18yo with Dx
  250.xx in their Problem List who had at least 1
  visit since 3/1/05.

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Aim Statement

• To promote a Culture of Innovation in order to
  improve various diabetes care parameters by at
  least 20 at the UW Medicine Auburn Clinic.

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Measures

• of patients w/ A1clt7
• Average A1c
• of patients w/ LDLlt100
• Average LDL
• of patients w/ BP lt130/80
• of patients w/ documented SMGs
• of patients w/ documented SCC

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The Planned Care Model
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Key Changes in Self Management Support and
Delivery System Design
Health System
Community
Organization of Health Care
Resources and Policies
Clinical Information Systems
Decision Support
Delivery System Design
Self-Management Support

• Planned Care
• F/u appt. at check-in
• Rx refill management
• Recheck BPs
• Reminder system
• Focused efforts

• Emphasize Pt. Role
• Assess readiness
• Capture activity
• Education

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Key Changes in Decision Support and Clinical
Information Systems
Health System
Community
Organization of Health Care
Resources and Policies
Self Management Support
Delivery System Design
Decision Support
Clinical InformationSystems

• Embedded guidelines
• Insulin in-service
• Guidelines for patients

• Registry
• Timely measures reporting to focus efforts
• Care reminders
• Care-planning

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Key Changes in Community Resources and Healthcare
Organization

• Began spread of the Planned Care Model to other
  clinics

• Began collaboration with nearby health club to
  improve access to exercise.

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Informed, Activated Patient
Prepared Practice Team
Productive Interactions

• Typical planned diabetes care visit
• Fasting lab tests already done about 1 week prior
  to visit
• Patient given standard Diabetes Visit
  Questionnaire
• MA rooms the patient and enters answers into EMR
• BP rechecked if gt130/80 to ensure accuracy
• Provider reviews each item with patient, assess
  change readiness, emphasizes self management role
  in achieving control.
• Provider must enter a plan for care measures that
  are not at goal
• Medications refilled for amount lasting to next
  interval follow-up
• Patient reminded regarding regular follow-ups

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Diabetes Visit Questionnaire

• What is your goal for this visit?
• What is the most difficult issue for you in
  managing your diabetes?
• Are you taking your medications/insulin everyday?
  
• Doing well on diabetic diet?
• Tobacco use Yes (Ready to quit? Yes / Not yet)
  
• How can we help?

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Examples of PDSA Cycles

• Capturing SCC and SMG activity utilized an EMR
  feature to drop in a quick note that is able to
  be pulled out electronically during data query.
• Improving BP parameter asked MAs to recheck BP
  if gt130/80, and working to move sphigmo from exam
  table to next to chair to have more accurate
  reading.

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Sample Run Charts
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Sample Run Charts
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Sample Run Charts
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Sample Run Charts
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Barriers

• Time
• Money

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Keys to Success

• Setting the proper tone and atmosphere for change
  and innovation
• Listening to providers, staff, and patients
• Make it fun
• Reward and celebrate even the smallest successes