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GO! Diabetes Train the Trainer Program. Practice Performance and Improvement. Diabetes Master Clinician Program. A quality assurance program that--- Promotes excellence in diabetes care Empowers Patients, Staff and Clinicians to achieve the best possible care
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Diabetes Master Clinician Program • A quality assurance program that--- • Promotes excellence in diabetes care • Empowers Patients, Staff and Clinicians to achieve the best possible care • Removes BLAME—throws out the word compliance and states that recognizing and overcoming barriers is the key to success • Addresses Clinician Barriers, Patient Barriers, Staff Barriers and System Barriers
Care that is Safe • Effective • Efficient • Equitable • Patient-centered • Timely • Evidenced-based • Institute of Medicine Crossing the Quality Chasm
How good is our Health Care • In the past two decades US health care has gone from being a source of National Pride to one of America’s pre-eminent concerns” Porter and Teisberg • “The US spends more on health care than any other industrialized nation ($5000 per person vs. $1500) but ranks at the bottom on standard measures of quality and health status” Commonwealth report and Steve Schroeder • “We have a large gap-chasm between the health care we have and the health care we could have” Institute of Medicine
What is the problem with our Health Care System? • It is not that Clinicians do not care • Our system of education and care designed for failure • Working hard but are we working smart? • “A significant part of the Quality problem in Health care is surprising and counterintuitive-Performance is rarely Measured” Donald Berwick MD CEO Institute of Health Care Improvement • “Mandatory measurement and reporting of results is the single most important step in reforming health care” Porter and Teisberg
Diabetes as a Model for Reform • Nationally many patients not receiving adequate care • Reaching ADA goals?? 48% reach HbA1c <7%, 33% reach LDL <100 and B/P < 130/80—7% all three • Excellent evidence (DCCT & UKPDS) that reducing HbA1c 1% ↓ blindness, renal disease and neuropathy 33% • Reaching goal for LDL and B/P ↓ MI and stroke 30 to 40% • Significant Cost Savings when goals are reached
Towers Perrin Actuarial Evaluation 2006 Bridges to Excellence http://www.bridgestoexcellence.org/assets/ Documents/Program_Evaluation_Documents/DCL_analysis1207051.pdf
The DMCP Diabetes Registry • Internet-Based system sponsored by the Florida Academy of Family Physicians Foundation • Measures achievement of evidenced-based guidelines from the ADA, NCEP, JNC7 • Driven by Family Physician Users • Produces reports to aid achievement of excellence in diabetes care.
September 2008
March 2009
Floyd Savings – March 2009 for DMCP Using Towers Perrin Data http://www.bridgestoexcellence.org/assets/Documents/Program_Evaluation_Documents/DCL_analysis1207051.pdf
The DMCP Diabetes Registry What are some possible strategies to improve excellence in diabetes care?
Diabetes Change Agents • Utilize the diabetes registry report card with every patient with diabetes • Develop a team system to encourage accountability • Standing protocol orders for staff to implement
Impact of Medical Assistants Over 8 month Period in 140 Patients • MA gave patients and physicians report cards • MA did the monofilament exams • MA ordered tests per protocol
Diabetes Change Agents:Three Month Goal – July 1, 2009 • Blood Pressure -Actively manage hypertension at every visit with a goal of <130/80 -Goal of 50% of patients blood pressure <130/80 • Aspirin -Recommend all patients with diabetes to take an 81mg ASA daily, unless contraindicated -Document aspirin use on medication list for 50% of patients
METRIC • Metric stands for Measuring, Evaluating, and Translating Research Into Care. • It is an innovative online practice improvement program where you will input records of 10 diabetic patients prior to today and again within 90 days. • www.aafp.org/metric