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The HbA1c Limbo: How low can you go?

The HbA1c Limbo: How low can you go? Experiments from the Learning Lab of Thundermist Health Center, Woonsocket Deb Chalko and Beni Seballos. THE CHALLENGE: “IT’S MULTIFACTORIAL.”. STAFF ENGAGEMENT Staffing New staff members Overload Data Tasks. PROVIDER ENGAGEMENT Staffing

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The HbA1c Limbo: How low can you go?

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  1. The HbA1c Limbo: How low can you go? Experiments from the Learning Lab of Thundermist Health Center, Woonsocket Deb Chalko and Beni Seballos

  2. THE CHALLENGE: “IT’S MULTIFACTORIAL.” • STAFF ENGAGEMENT • Staffing • New staff members • Overload • Data • Tasks • PROVIDER ENGAGEMENT • Staffing • Understaffing • New providers • Overload • Data • Tasks • PATIENT ENGAGEMENT • Volume • 800 DM2 patients • New DM2 patients • Lost to follow-up • Psycho-social factors • Financial • Complex patients

  3. THE RESPONSE: “IT’S MULTIFACTORIAL.” PATIENT ENGAGEMENT Group visits Walking groups STAFF ENGAGEMENT Usable data Continuing education Incentives/rewards PROVIDER ENGAGEMENT Usable data Staff support Patient resources Continuing education

  4. PROVIDER ENGAGEMENT: USABLE DATAYou can lead a horse to water, but try not to drown it. • CDSS alerts and flow sheets • Provider Level Summary • Pro- Active Pre-visit Planning • Missed Opportunities Report • Monthly emails on PDSA standings • Quality Meetings PROVIDER ENGAGEMENT Usable data Staff support Patient resources Continuing education

  5. PROVIDER ENGAGEMENT: USABLE DATAYou can lead a horse to water, but try not to drown it. PROVIDER ENGAGEMENT Usable data Staff support Patient resources Continuing education

  6. PATIENT ENGAGEMENT: GROUP VISITSYou can lead a horse to water, but make sure it’s thirsty. PATIENT ENGAGEMENT Group visits Walking groups

  7. STAFF ENGAGEMENT: INCENTIVES/REWARDSYou can lead a horse to water, but offer bubbly. MISSION: CONTROL! STAFF ENGAGEMENT Usable data Continuing education Incentives/rewards

  8. THE RESPONSE: “IT’S MULTIFACTORIAL.” STAFF ENGAGEMENT Usable data Continuing education Incentives/rewards PROVIDER ENGAGEMENT Usable data Continuing education Patient resources Staff support PATIENT ENGAGEMENT Group visits Walking groups

  9. THE CHALLENGE: “IT’S MULTIFACTORIAL.” • PROVIDER ENGAGEMENT • Staffing • Understaffing • New providers • Overload • Data • Tasks • PATIENT ENGAGEMENT • Volume • 844 DM2 patients (11.5%) • New DM2 patients • Gain 50/quarter • 19 (38%) HbA1c < 8 • Contrast: Established patients 57% HbA1c < 8 • Lost to follow-up • 40-70 not seen in 12 mos • Psycho-social factors • Financial • 206 (24%) uninsured • Complex patients • 286 (34%) Medicaid • STAFF ENGAGEMENT • Staffing • New staff members • Overload • Data • Tasks

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