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Diabetes Measures in EHRs Linked to Improved Care

Diabetes Measures in EHRs Linked to Improved Care. Omar A. Contreras, MPH Diabetes Prevention and Control Program Arizona Department of Health Services June 27, 2014. What does What does medicine do? public h ealth do?.

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Diabetes Measures in EHRs Linked to Improved Care

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  1. Diabetes Measures in EHRs Linked to Improved Care Omar A. Contreras, MPH Diabetes Prevention and Control Program Arizona Department of Health Services June 27, 2014

  2. What does What does medicine do? public health do? Saves lives one at a time Saves lives millions at a time

  3. Essential Services of Public Health • Enforce laws and regulations • Link people to needed services/assure care • Assure a competent workforce • Evaluate health services • Research • Monitor health status • Diagnose and investigate • Inform, educate, and empower • Mobilize community partnerships • Develop policies and plans Source of Ten Essential Public Health Services: Core Public Health Functions Steering Committee, 1994

  4. Framework for Improving the Performance of Public Health Health Department + PH System + Community Partners + Workforce Operational Capacity (Infrastructure) Every Community Program and Public Health Activity (Chronic Disease, Inf. Disease, EH) Better Health Outcomes Reduced Disparities Better Preparedness Which leads to Builds Impacts Investments here Pay big dividends here Source: D. Lenaway. Centers for Disease Control and Prevention, Office of Chief of Public Health Practice. 2009 (unpublished)

  5. Governmental Public Health State and Local Health Departments Retain the primary responsibility for health under the US Constitution State and the District of Columbia Health Departments 51** Tribal Health Departments Local Health Departments 2,565* Territorial Health Departments 8** * Number based on 2010 National Profile of Local Health Departments (NACCHO, 2011) ** Numbers cited from ASTHO, Profile of State Public Health, Volume Two, 2011

  6. State and the District of Columbia Health Departments 51** Territorial Health Departments 8** Federally Qualified Health Centers Tribal Health Departments Local Health Departments 2,565*

  7. Outline • Arizona Department of Health Services/Arizona Diabetes Program • Diabetes in Arizona • Epidemiology and Surveillance • Trends and Cost Analyses • The Arizona Diabetes Coalition • Diabetes measures and systems change • Public Health in Action Grant • EHR and non-physician team base approach to diabetes care • Summary

  8. Arizona Department of Health Services Hierarchy

  9. Arizona Diabetes Program What we do and what we provide? • Ongoing technical assistance to internal and external partners • Information and guidance on funding resources • Develop diabetes specific strategies and public health interventions at a systematic, policy, and environmental levels • Supports and oversees the activities Arizona Diabetes Coalition and Leadership Council

  10. Diabetes in Arizona

  11. Leading causes of death in the United States for 2011 Source: National Center for Health Statistics, www.cdc.gov/nchs.

  12. Diabetes in Arizona • 1/9 Arizonans have diabetes • 1/3 of those who have diabetes in Arizona are unaware that they have it • Diabetes is the leading cause of new cases of blindness and kidney failure • Known risk factors • Obesity • Physical inactivity or increase in sedentary lifestyle • Built environment

  13. How do rate by county? *Source: Arizona Behavioral Risk Factor Surveillance System, (AZ-BRFSS, 2013) ** 2011 Numbers shown as 2012 data not available

  14. Arizona Adults with Diabetes by Race/Ethnicity, 2012 Prevalence (%) Source: AZ Health Matters (2012), AZ BRFSS

  15. Arizona Age-adjusted Death Rate due to Diabetes, by Gender (2012) Source: AZ Health Matters (2012), AZ BRFSS

  16. Arizona Age-adjusted Death Rate due to Diabetes, by Race/Ethnicity (2012) Rate per 100,000 population Source: AZ Health Matters (2012), AZ BRFSS

  17. Estimated costs Source: http://www.diabetes.org/advocate/resources/cost-of-diabetes.html, retrieved 11/25/2013

  18. Estimated costs AZ, cont. 2011 Arizona Hospital Discharge Data indicated a total of 7,065 discharges related to diabetes and chronic conditions. $167,815,464 Arizona Diabetes Cost Data (2010) – CDC Chronic Disease Cost Calculator

  19. Arizona Diabetes Coalition

  20. Vision A state without diabetes Mission To reduce the health, social, and economic burden of diabetes in Arizona

  21. How are the Coalition and Council structured?

  22. Arizona Diabetes Leadership Council • Reorganized Fall 2006 • >18-21 member leadership council • Representation from academia, health plans, government, private companies, non-profit organizations, etc. • Meet 6 times a year as a council and quarterly with the coalition • Each Coalition workgroup chair is represented in the Leadership Council. • Ex-Officio members • Well established by-laws: www.azdiabetes.gov • Constant communication between leadership body and ADHS Diabetes Program

  23. Diabetes Measures and Systems Change

  24. Health Care Flowchart

  25. Pillars of Health Care Reform Cost Coverage Quality Access

  26. Quality and access to CareThere are thousands of new doctors and nurses in communities around the country and millions more patients getting care.

  27. Improving Quality • Increase the utilization of EHR in multiple healthcare systems • Encourage completion of NQF standard measures for diabetes and hypertension • Require reporting and accountability for health plans • Coordinate care and medical home models • Improve patient safety, reduce medical errors, promote health and wellness • Capacity development for FQHCs and other health systems

  28. National Quality Forum (NQF) Measures (Diabetes)

  29. Role of EHR systems in FQHCs • Advocate for your patients • Referral mechanism for DSME and prevention programs • Provision of preventative care for chronic care patients • EHRscan help avoid re-admission rates and improve and adherence to self-management

  30. Public Health in Actions Grant

  31. What is the Public Health in Actions Grant? • 5 year collaborative grant • Focuses on policy, system, and environmental change • 32 states funded • Basic and Enhanced components • Year 1 has been completed

  32. Implementation of EHR system change and performance measures • Proportion of health care systems reporting on NQF measures 18 and 59 • Proportion of health care systems with EHRs appropriate for treating patients with high blood pressure and diabetes • Increase the institutionalization and monitoring of aggregated/standardized quality measures at the provider and systems level

  33. System level changes and non-physician team based care in Federally Qualified Health Centers

  34. Summary • Diabetes remains a prevalent disease in Arizona, specifically in rural areas • Diabetes NQF measures offers the ability to detect care when the recommended care was given or when recommended care was not received. • Non-physician staff will continue to be on high demand and integration into a team base approach to diabetes health should be warranted • Health systems changes via the utilization of electronic health records show positive trends in the improvement of diabetes care

  35. Looking into the future • Establish a data sharing agreement between ADHS and FQHCs and/or the Alliance for Community Health Centers • Ability to generate standardize reports on patients with diabetes and hypertension • Reducing the gaps and inconsistencies resulting in lack of data within the EHR

  36. Our ever changing public health system Philanthropist Nursing Homes Churches FQHCS Home Health Doctors Employers Economic Development Police MCDPH ADHS EMS Laboratory Facilities Parks Schools Elected Officials Hospitals Mass Transit Environmental Health Civic Groups Fire Urban Planners Tribal Health Drug Treatment Corrections Mental Health

  37. Questions? Contact Information Omar A. Contreras, MPH Diabetes Prevention and Control Program Manager Arizona Department of Health Services omar.contreras@azdhs.gov (602) 542-2758

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