Internal Medicine PILDP Team February 18, 2011 Getting a Leg Up
on Diabetes Control
Slide 2
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
Slide 3
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
Slide 4
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
Slide 5
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
Slide 6
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
Slide 7
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
Slide 8
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
Slide 9
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
Slide 10
The Project
Slide 11
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
Slide 12
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