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Office Strategies to Improve Diabetic Clinical Measures

Three Rivers Community Health GroupServing Perry, Hickman, and surrounding counties

Jeffrey G. Smith, MD, Family Physician, CMOLeAnne Warren, RN, Care Manager Kirstie Allen, LPN, QI Coordinator

ObjectiveUnderstanding the role that quality

improvement initiatives have on improving health outcomes particularly with regards to Diabetic care

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The Diabetes Belt

US Prevalence of Diabetes

UDS (Uniform Data System) Table 7

Diabetes Clinical Measures

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HbA1cGlycated hemoglobin in the blood

• Measures the average blood glucose level for the last 2-3 months (which is the predicted half life of RBCs)

• Standard of care for testing and monitoring diabetes

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• HbA1c also correlates with • Lipids, primarily

triglycerides • Inversely with HDL• Cardiovascular disease• Stroke

• Increase of 1% of HbA1c concentration is associated with

• 30% increase in all case mortality

• 40% increase in cardiovascular or ischemic heart disease mortality among individuals with diabetes

HbA1c Ranges

Nondiabetic 4% – 5.6%

Prediabetic 5.7% – 6.4%

Diabetic > 6.5%

Poor Control Diabetes > 9%

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16%

17%

Total = 33%

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Provider Quarterly UDS Reports - Group

16%

16%

Provider Quarterly UDS Reports - Individual

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HbA1c UDS Measures for our combined clinics over recent years

HbA1c > 9% or unknown percentage totals

2015 34%2016 30%2017 29%2018 34% (January – June)

Improving Diabetes performance measures is challenging because we deal with so many humans.

Staff Providers Patients

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Ways we work with staff and providers:

Education

Huddle Times

Limit medication refills to every 3-6 months to ensure follow-up

Urge providers to do yearly care-plans for diabetes

Quarterly peer review of providers, patient care, and disease management

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Daily Team Huddle to review next day patients with

• Front office• Nursing• Provider staff

Using i2i Tracks

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Ways we work with patients to improve HbA1c:

Yearly diabetic care-plans provided by providers and/or nurses

Encourage regular 3-6 month office follow-ups by limiting medication refills

Education

Dietician Referral – Dietitian Associates through TeleHealth (free service to the uninsured)

Calling patients who are behind on follow-ups or have poor control diabetes for office visits

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Total Patients with Diabetes Patients that have NOT had a HbA1c since January 2018

Patients that have had a HbA1c since January 2018

Patients with HbA1c > 9

Data from i2i Tracks – can be used to call patients in for visits

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References

https://www.wellcare.com/.../PDFs/.../na_hedis_adult_resource_guide_eng_01_2016

https://www.tn.gov/content/dam/tn/health/documents/Diabetes.pdf

https://bettertennessee.com/health-brief-diabetes-in-tennessee

https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

Sherwani et al. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomarker Insights 2016: 11 95-104 doi: 10,4137/BMI.S38440