UNIVERSITY OF MISSOURI
Family & Community Medicine
Improving Perfect Diabetes Care
Performance Improvement Leadership Develop Program
February 19, 2010
UNIVERSITY OF MISSOURIFamily & Community Medicine
Members of the Team and our Advisors
• Karl Kochendorfer, MD (Dir. of Clin. Inform.)• Phil Vinyard, MHA, MBA (Clinic Manager)• Donna Neal, RN (Nurse Manager)• Rhonda Polly, APRN (Chronic Care Nurse)• Jan Gace, LPN (Phone + Floor Nurse)
Advisors:• Carl Hooker, MHA (Finance)• Tim Hogan, PhD (Dept. QI Officer)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Family Medicine
• 8 Clinics in Columbia + Mid-Missouri• ~100,000 ambulatory clinic visits/year• Pilot with Green Meadows Green Team
450 patients with diabetes 7 Faculty members 1 Fellow 9 Residents 1 Chronic Care Nurse 9-11 Nurses 7 Clerical
UNIVERSITY OF MISSOURIFamily & Community Medicine
Chronic Disease and Diabetes Burden
• Half of all Americans have at least one 1
• 70% of all deaths 2
• > 75% of health expenditures 1,3
• 1/5 of health dollars are spent on pts with diabetes 4
• Only 50% of recommended care is delivered 5
1) Wu. Projection of chronic illness prevalence and cost inflation. RAND Health; 2000. 2) Kung. Deaths: final data for 2005. National Vital Statistics Reports 2008.3) Hoffman, C. Persons With Chronic Conditions - Their Prevalence and Costs. JAMA. 1996.4) ADA. Economic Costs of Diabetes in the U.S. in 2007. Diabetes Care. March, 2008.5) McGlynn. Quality of Health Care Delivered to Adults in the US. NEJM. 2003.
UNIVERSITY OF MISSOURIFamily & Community Medicine
Broken healthcare system
“Good Luck with the American Health-Care System” cards
UNIVERSITY OF MISSOURIFamily & Community Medicine
Concept of Perfect Care
Healthcare IT News. 9/2008
UNIVERSITY OF MISSOURIFamily & Community Medicine
Min. improvement after 1 yr
Clinics w/ Care Coordinators:• 2 FM Clinics b/w 10-15%• 2 FM Clinics b/w 5-10%
Clinics w/o Care Coordinators:• 4 FM Clinics close to 0%• 2 IM Clinics close to 0%
UNIVERSITY OF MISSOURIFamily & Community Medicine
Aim Statement
The Family Medicine Green Team will increase the percentage of our diabetic patients with perfect care from 10% to no less than 50% by June 30, 2010. This will be accomplished by using a multidisciplinary approach, process change, education and utilization of eight quality measures.
UNIVERSITY OF MISSOURIFamily & Community Medicine
UMHC & FCM Mission & Focus
• UMHC Mission: advance the health of all people, especially Missourians
• UMHC Focus: Six Columns of Excellence Quality People Service Growth Community Finance
• FCM Mission: enhance health and primary care for our communities
• FCM Research Focus: preventing and caring for patients with chronic disease
UNIVERSITY OF MISSOURIFamily & Community Medicine
Interventions Considered
• Opportunistic Approach: Every time a patient with diabetes comes
for a clinic visit, review their quality measures and take action
• Proactive Approach: “Run the list” of diabetic patients and pro-
actively contact them about missing items• Patient Engagement Approach:
Educate the patients about the types of services they should be receiving
UNIVERSITY OF MISSOURIFamily & Community Medicine
Outcomes to DateGreen Team Diabetes Perfect Care* as of 01/14/2010
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
03/12/2
009
03/26/2
009
04/09/2
009
04/23/2
009
05/07/2
009
05/21/2
009
06/04/2
009
06/18/2
009
07/02/2
009
07/16/2
009
07/30/2
009
08/13/2
009
08/27/2
009
09/10/2
009
09/24/2
009
10/08/2
009
10/22/2
009
11/05/2
009
11/19/2
009
12/03/2
009
12/17/2
009
12/31/2
009
01/14/2
010
*Perfect care indicates performance of all 8 DM indicators
Perc
ent p
erfo
rman
ce
Decided to focus on diabetes quality indicators as a practice improvement project
Completed workflow process and began piloting and training for our intervention
UNIVERSITY OF MISSOURIFamily & Community Medicine
System-wide ROI
• Eye exams (Mason): $25,000/yr from GM Green Team patients When all clinics get to 80% referral rate $225,000/yr in new and return visits $75,000/yr in facility fees
• GM Quality of Care: priceless From < 10% to 20% in a few months Target 50% by June 30th, 2010
UNIVERSITY OF MISSOURIFamily & Community Medicine
Lessons Learned
• Having data doesn’t mean improvement• Integrate the data into your workflow• Training needs
Learning how to use the reporting tools Documentation, e.g. eye and foot exams
• Team effort (e.g. buy-in, resources, meetings)
• Physician led team• Automate, Automate, Automate
UNIVERSITY OF MISSOURIFamily & Community Medicine
Future Steps
• Present to FCM Faculty on March 24th
• Celebrate target achievement on 7/1/10• Publish an article in a national journal• Present at Practice Improvement conf.• Integrate PDSA
Continue Meeting (1x/mo) Work on “Proactive” approach Work on “Patient Engagement” approach Expand to other FM + IM Clinics Assist our docs with their Board cert.