Next Steps

1. Next Steps Robert A. Gabbay, MD, PhD Professor of Medicine, Penn State College of Medicine

2. Until we meet again… • Use your practice facilitator as a resource. • Meet with and call Patty/Sharon: Pick a date today! • Reflect on and respond to their feedback • Continue (or start) holding weekly team meetings. • Develop a plan to collect any data you don’t have or correct any data you know is wrong. • Identify diabetes patients overdue for visits and reach out to them to schedule a visit and provide follow-up care.

3. Until we meet again… • Continue implementing critical changes on monthly reporting form. • Population alert • Template/flow sheet • Standing orders • Huddles • Planned care at every visit • Patient report cards • Patient self-mgmt goals • Risk assessment at every visit • Follow-up care for high-risk

4. Until we meet again… • Show significant and sustained improvement in at least 1 outcome measure and 3 process measures. • Keep on reporting PDSAs, data, status reports. • Participate in webinars: 12pm-1pm • Feb. 21 ▪ March 28 • April date tba • Tell us what you need!

5. Monthly Report Due Dates • February 5 • March 5 • April 5 • May 6 • June 5

6. Learning Session #4 South Central • May 9: 5-9pm at PSU College of Medicine, Hershey Northwest • May 16: 5-9pm at Cross Creek Resort, Titusville

7. Practice Facilitators • Northwest Patricia J. Stubber, MBA Executive Director Northwest PA AHEC 8425 Peach Street Erie, PA 16509-4788 814-217-6029 (phone) 814-594-4740 (cell) 814-864-4077 (fax) pstubber@nwpaahec.org • South Central Sharon M. Adams RN, BA Executive Director Southcentral PA AHEC PO Box 509 Carrolltown, PA 15722 814-344-2222 (phone) 814-344-2221 (fax) sadams@scpa-ahec.org Web: www.paspread.com Email: paspread@hmc.psu.edu