Jolene Johnson, MD Associate Clinical Professor of Medicine, LSU School of Medicine

Jolene Johnson, MDAssociate Clinical Professor of Medicine,

LSU School of MedicineHead, Statewide Diabetes Disease Management,

LSU HCSD

Benefits of LSU ICON for Diabetes Disease Management

• Project Design and Protocol Development• IRB Submissions and Approvals• Database Development and Management• Data Analysis/Statistical Support • Dedicated Patient Interaction Specialists to

Assist in Recruitment and Data Collection

• Diabetes Interest Group– Assisting Diabetes Management Group in the

development and testing of procedures associated with the expansion of the scope of its programs and services• Diabetes Screening Techniques• Treatment Strategies for Pre-Diabetes • Hepatitis B Immunization

Benefits of LSU ICON for Diabetes Disease Management

Current LSU ICON Diabetes Disease Management Projects

Implementing Screening for Diabetes and Pre-Diabetes within the LSU HCSD Medical Home Clinics

Jolene Johnson, MD and Ronald Horswell, PhDPrincipal Investigators

Jay Besse, BS and Rob Leonhard, MBACo-Investigators

Designing Screening Algorithms for Diabetes and Pre-Diabetes

Ronald Horswell, PhD Principal Investigator

Gang Hu, MD, PhD and Jolene Johnson, MDCo-Investigators


Overview: • This Quality Improvement project pilots a specific

diabetes screening protocol and follow-up program. • This pilot was conducted at three LSU HCSD medical

home clinics. • If the pilot protocol and follow-up program prove

feasible and sustainable, they will be implemented at other LSU HCSD medical home clinics.


Specific Aims: • Aim 1: Pilot at three LSU HCSD Medical Home clinics a new diabetes screening program

that consists of using the newly-developed LSU Diabetes/Pre-diabetes Screening Protocol (“Screening Protocol”) to identify previously undiagnosed diabetes patients and pre-diabetes patients.

• Aim 2: Assess the feasibility and sustainability of the screening program.If Aim 2 demonstrates feasibility and sustainability of the screening program, or suggests feasibility and sustainability can be achieved with only minor modifications, the project will move on to Aims 3 and 4.

• Aim 3: Implement (via a phased roll-out) the screening program (“Screening Protocol” and “Follow-up Protocol”) across LSU Health medical home clinics.

• Aim 4: Evaluate the clinical effectiveness of the screening program.


Project was piloted for 2,830 patients who visited three Medical Home Clinics at Earl K. Long from January 14, 2013 to February 28, 2013. – North Baton Rouge– South Baton Rouge– Family Practice Clinic


Exclusion by Administration Data ?

Screened?

Screening stop boxes for exclusion?

Yes

No

NoYes

YesNo

Unique visitors (2830) A

Visitors (1714) D

Screened (841)F

Existing Diabetes Diagnosis (75) G

Recently Tested (371) H

Ordered (190)M

Done (130)O

Age<45 & BMI<25 (51) I

Normal (55) Q

Pre-diabetes (63) R

Diabetes (12) S

Pending (60)P

Not Ordered (22) N

2+ Risk Factors (212) K

Not screened (873) E

Diabetes (817)B

Less than 2 Risk Factors (132) L

Cancer, HIV or ESRD (299) C

Risk Factors Assessed (344) J

Group Name (# of subjects)

Decision

Legend

Results: 5.7%

Prevalence of previously undiagnosed patients with diabetes identified among those with two or more risk

factors visiting the pilot clinics

Based upon the LSU HCSD Medical Home volume of 101,000 unique adult patients annually, 1420 patients would be

identified by the screening protocol as having diabetes if conducted for one year


Results:29.9%

Prevalence of previously undiagnosed pre-diabetic patients among those with two or more risk factors

visiting the pilot clinics.

Based upon the LSU HCSD Medical Home volume of 101,000 unique adult patients annually, 7,470 patients would be

identified by the screening protocol as having pre-diabetes if conducted for one year


Overall Impact of Projects on Improvement of Health Outcomes

The identification of a large number of undiagnosed patients with pre-diabetes highlights the need for a

treatment strategy. Therefore, feasible and inexpensive interventions for patients with pre-diabetes should be

defined and tested.

Current LSU ICON Diabetes Disease Management Projects


Jolene Johnson, MD and Ronald Horswell, PhDPrincipal Investigators

Jay Besse, BS and Rob Leonhard, MBACo-Investigators


Ronald Horswell, PhD Principal Investigator

Gang Hu, MD, PhD and Jolene Johnson, MDCo-Investigators


Overview:• This Quality Improvement Project is gathering

data necessary to evaluate alternative screening algorithms for identifying previously undiagnosed patients with diabetes and pre-diabetes.

• The immediate application of these results will be the development of a cost effective screening algorithm(s) for use within the LSU Health delivery system.


Specific Aims• Aim 1: Estimate and compare the achievable combinations of

sensitivity and specificity obtainable by the candidate screening protocols involving single or multiple component tests.

• Aim 2: Determine if risk factor assessment via either the American Diabetes Association’s risk factor instrument and/or the FINDRISC instrument improves screening algorithm performance.

• Aim 3: Conduct cost effectiveness analysis comparing the candidate algorithms.

DETERMINING CLINICAL DIABETES DIAGNOSIS







Results:

• Risk factor screening instruments, utilized as typically recommended (e.g.: ADA 2+ risk factors), reduce the cost per person screened, but have a maximum sensitivity of 80%.

• Suggests the need to be selective in establishing screening instrument cut off points.

Overall Impact of Project on Improvement of Health Outcomes

To maximize the sensitivity and minimize the cost of diabetes screening

Comparing Cost Effectiveness of Two Methodologies for Assessing Diabetic Patients for Hepatitis B Vaccines

Within the Medical Home ClinicJolene Johnson, MD and Ronald Horswell, PhD

Principal Investigators

Proposed LSU ICON Diabetes Disease Management Project

Overview:• Two general strategies for Hepatitis B vaccination

– Test for immunity prior to vaccination– Immunize all patients

• Critical information for determining optimal strategy includes: – Cost of immunity testing– Cost of immunization– Baseline prevalence of immunity in the population

Proposed LSU ICON Diabetes Disease Management Project

Documents

Jolene Johnson, MD Associate Clinical Professor of Medicine, LSU School of Medicine