the hba1c limbo: how low can you go? experiments from the learning lab of thundermist health center,...
TRANSCRIPT
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.”
PROVIDER ENGAGEMENTStaffing
UnderstaffingNew providers
OverloadDataTasks
PATIENT ENGAGEMENTVolume
800 DM2 patientsNew DM2 patientsLost to follow-up
Psycho-social factorsFinancialComplex patients
STAFF ENGAGEMENTStaffing
New staff membersOverload
DataTasks
PROVIDER ENGAGEMENTUsable dataStaff supportPatient resourcesContinuing education
PATIENT ENGAGEMENTGroup visitsWalking groups
STAFF ENGAGEMENTUsable dataContinuing educationIncentives/rewards
THE RESPONSE: “IT’S MULTIFACTORIAL.”
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 MeetingsPROVIDER ENGAGEMENT
Usable dataStaff supportPatient resourcesContinuing education
PROVIDER ENGAGEMENT: USABLE DATAYou can lead a horse to water, but try not to drown it.
PROVIDER ENGAGEMENTUsable dataStaff supportPatient resourcesContinuing education
PATIENT ENGAGEMENT: GROUP VISITSYou can lead a horse to water, but make sure it’s thirsty.
PATIENT ENGAGEMENTGroup visitsWalking groups
Jan-10 Jan-110
2
4
6
8
10
12
14
16
HbA1c
CarmenMilviaAmparoAntonioAngelIrisVelmaRobertoSaraNoe
STAFF ENGAGEMENT: INCENTIVES/REWARDSYou can lead a horse to water, but offer bubbly.
STAFF ENGAGEMENTUsable dataContinuing educationIncentives/rewards
Patient initials and visit date
LDL in last 9 months
LEAP in last 9 months
FLU VACCINEIn last 9 months
SM GOAL in last 9 months
EYE EXAMin last 9 months
MISSION: CONTROL!
PROVIDER ENGAGEMENTUsable dataContinuing educationPatient resourcesStaff support
PATIENT ENGAGEMENTGroup visitsWalking groups
STAFF ENGAGEMENTUsable dataContinuing educationIncentives/rewards
THE RESPONSE: “IT’S MULTIFACTORIAL.”
Jan-10 Jan-1102468
10121416 Carmen
MilviaAmparoAntonioAngelIrisVelmaRobertoSaraNoe
THE CHALLENGE: “IT’S MULTIFACTORIAL.”
PROVIDER ENGAGEMENTStaffing
UnderstaffingNew providers
OverloadDataTasks
PATIENT ENGAGEMENTVolume
844 DM2 patients (11.5%)New DM2 patients
Gain 50/quarter19 (38%) HbA1c < 8 Contrast: Established patients 57%
HbA1c < 8Lost to follow-up
40-70 not seen in 12 mosPsycho-social factors
Financial206 (24%) uninsured
Complex patients286 (34%) Medicaid
STAFF ENGAGEMENTStaffing
New staff membersOverload
DataTasks