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Internal Medicine PILDP Team February 18, 2011 Getting a Leg Up on Diabetes Control

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Team Members & Roles Members Dr. Jim Koller, MD Amanda Lewis, LPN BJ Boshard, RN, MS Divya Gupta, MD, Resident Jyotsna Reddy, MD, Resident Roles Leader/Front Line Team Member/Front Line Facilitator/Recorder Team Member/Front Line

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Team Supporters Advisors Kristin Harlan Lynn Keplinger, MD Sponsors Dr. David Fleming Dr. Bob Lancey Special Partners UMHC Koby Clements Data Guru Karen Broz Resident IT Training Coordinator VA Tim Anderson Patient Safety Crystal Aholt Patient Safety Alan Villiers IT Guru 02/17/2011

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Blue = Thinking/Facilitating Red = Emotional White = Information/Data Black = Logic Green = Creativity Yellow = Hopeful/Optimistic Six Hat Thinking by Edward De Bono DeBono E, Six Thinking Hats, Little, Brown, & Co, Boston, 1985 02/17/2011

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Promotes Parallel/Directional Thinking Manages multiple thoughts Allows one think at a time Changes the direction of the train Easy to use Removes judgment about right or wrong Allows us to focus on what we can do! Purpose of 6 Hat Thinking 02/17/2011

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Problem We Would Like to Achieve Better: Management of Chronic Diseases Monitoring of Resident Performance Compliance with ACGME Requirements for Chronic Disease Management and Preventive Care Change Hypotheses Providing data will: Increase effective care (based on standards of care/evidence- based medicine) Increase the patient partnership in their own care Create a culture of quality measurement in physician practice Comply with ACGME 02/17/2011

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Relationship to Strategic Goals of Institution or Department Service and Quality Use of EMR to achieve patient- centered outcomes through monitoring Achieve standards of care for DM Improve interactions with patients through informed, active patients Focus on one of the top 7 health risk factors for Missouri Intersection With Patient Centered Care Use of EMR by providers to know whether they are meeting established standards of care for patients/panels of patients with chronic diseases (DM) Use of EMR to be able to share with patients their management of diabetes for 8 performance measures Partner with patients to improve performance on diabetes measures 02/17/2011

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Business Case Patient Costs: Quality Care Patient Retention Patient Acquisition Increased Hospitalizations Increased Morbidity Increased Mortality Other Costs: Loss of accreditation Loss of Manpower at (VA & UMHC) Reputation Impact on School of Medicine Fellowships would disappear 02/17/2011

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The of Diabetes USA* $174,000,000,000 Missouri ** $2,720,000,000 Missouri, District 9* $305,800,000 Missouri Individual** $11,734 Proj. Generated Revenue- Continuity Clinic FY 2011 $470,000 UMHC 1990 Review*** $17:$1 *(ADA) Cost Calculator 2007: http://www.diabetesarchive.net/advocacy-and-legalresources/cost- of-diabetes- results.jsp?state=Missouri&district=2909&DistName=Congressional +District+9 http://www.diabetesarchive.net/advocacy-and-legalresources/cost- of-diabetes- results.jsp?state=Missouri&district=2909&DistName=Congressional +District+9 **MODHSS, Diabetes Burden Report & State Plan, May 2009 http://www.dhss.mo.gov/living/healthcondiseases/chronic/diabetes /index.php http://www.dhss.mo.gov/living/healthcondiseases/chronic/diabetes /index.php ***For every $1 spent within the Diabetes Center for the care of a patient, that same patient spent $17 elsewhere within the UMHC system. (UMHC Diabetes Center) Diabetes hospitalizations for Missouri residents under 65 in 2006 considered preventable = 74%** 11% of all direct medical spending by Missourians is on diabetes care** MO Prevalence = doubled last 10 years from 4.4% to 8.0%** 02/17/2011

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The Project

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Initial Aim 8/27/10 Specific Aim: Improve achievement of standards for chronic disease management and control, (pilot - specifically diabetes & mammography screening), by improving resident education and performance on ___ diabetes performance measures (which ones/or all) and ordering of mammograms for women 50 and older; and the ability of faculty to routinely (every 6 mos) evaluate and discuss resident performance on these measures by June 2011 in all IM resident continuity clinics. 02/17/2011

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Evolving AIM 1.Improve group resident performance in all IM resident outpatient clinics (Fairview/Woodrail/VA) for all 8 Diabetes (DM) care performance measures - from ____*to ____ by June 2011 DM1 from 91% to 95% (HgA1c) DM2 from 77% to 90% (HgA1c < 9) DM3 from 70% to 90% (BP < 140/90) DM4 from 82% to 90% (LDL) DM5 from 73% to 90% (LDL