Using A Diabetes Registry: Lessons from Our Office Merced Faculty Associates Atwater, CA Family Medicine Summit Creating the Patient-Centered Medical Home.

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Presentation transcript:

Using A Diabetes Registry: Lessons from Our Office Merced Faculty Associates Atwater, CA Family Medicine Summit Creating the Patient-Centered Medical Home San Francisco Nov. 15, 2008 Isaac Kim, MD Merced Family Medicine Residency

Our Office One of offices of Merced Faculty Associates Medical Group, Inc. In the “evaluation” phase of EMR/EHR’s Core providers: –One half-time family physician (equivalent) –One full-time physician assistant –One full-time nurse practitioner

Our Office Total DM patients: 216 (active, not pre-DM) Medi-Cal: 7/216 (3.2%) Medicare:67/216 (31%) 2007 no-show rate: 7%(of 10,700 visits)

What is a registry? “a computer application used to capture, manage, and provide information on specific conditions to support organized care management of patients” 1.Aggregate reports: population tracking. “How do my/our patients measure up?” - may be used for P4P 2.Patient report: reminder system, safety net, visit planner “How do I remind myself to help my patient improve core measures?” - replaces the DM flow sheet 3.Outreach reports: proactive management, case management. “How do I identify patients who are poorly-controlled on a regular basis?”

Why did we start a DM registry? Outcomes will improve… or will they? –DM a top chronic medical condition which causes morbidity & mortality Dr. Adubofour’s challenge: how do you know -- how your patients measure up – without collecting data from your own patients’ charts? CAFP* New Directions in Diabetes Care collaborative: free DocSite ® registry (2-year subscription), timeline to implement P4P Bridge / transition / rehearsal towards EMR/EHR Overall burden/commitment: low –Data entry work: 0.5 hours/wk, charts/wk *California Academy of Family Physicians

Steps of Implementation April 2007: baseline data entry –DM flow sheets continue to be used as before –Data entry specialist went through A-Z in records room and entered into registry if: Master Problem List indicates DM (not pre-DM) Seen < 1 year in our office

Steps of Implementation July 2007: Visit Planner system –Replaced the DM flow sheet –Printed from registry and placed in charts the day before office visit, for any reason in front of the Master Problem List –Provider sees patient then checks Visit Planner to see if any Care Opportunities exist: make some changes right away, or arrange follow-up appt (with labs beforehand if needed) –Provider makes corrections, updates the Visit Planner –Records pulls and places on data entry specialist’s desk –Updated Visit Planner is printed the day before next visit

Steps of Implementation March 2008: First outreach report 1.Last visit >6 months 2.Most recent SBP >150 3.A1c >9.0% (21 patients) Oct 2008: Second outreach report

Setbacks “R” Us Trained: 1st MA/data entry person -- moved unexpectedly Trained: 2nd MA/data entry specialist – unable to adapt FNP: illness – long absence PA-C: illness – long absence Personal time constraints

What have we learned… so far? Physician champion is the key to success. Enlist support of all office staff. Data entry specialist is important. The Visit Planner and the Outreach reports have “sold us” on the value a DM registry.

In closing… “…those with diabetes received only 45% of care known to reduce costly and debilitating complications…” (McGlynn, E. et al, “The Quality of Health Care Delivered to Adults in the United States,” NEJM, 348;26, , June 26, 2003) “…diabetes often is poorly controlled despite adequate access to health care resources. Over 58% of patients with diabetes have an A1C >7.0% and over 15% have levels >10.0%...” (Thomas KG et al, “Use of a registry-generated audit, feedback, and patient reminder intervention in an internal medicine resident clinic--a randomized trial,” J Gen Intern Med Dec;22(12): Epub 2007 Nov 1)

Helpful Resources 1.“Using Computerized Registries in Chronic Disease Care” “Patient registries: a key step to quality improvement” “Using a Simple Patient Registry to Improve Your Chronic Disease Care” Free MS Excel spreadsheet DM registry. 4.“From Paper to Propietary: Patient Registries” Offers the nuts and bolts of implementing a patient registry. design.php 5.“Benefits of information technology-enabled diabetes management,” (Bu D et al. Diabetes Care May;30(5): Epub 2007 Feb 23) 6.“Use of a registry-generated audit, feedback, and patient reminder intervention in an internal medicine resident clinic--a randomized trial,” (Thomas KG et al. J Gen Intern Med Dec;22(12): Epub 2007 Nov 1) Point of contact: (209)