Diabetes Management DSRIP Project Methodist Dallas Medical Center Diabetes Management DSRIP Project February 18, 2015

Methodist Health System About Methodist Health System Methodist Health System is one of North Texas' oldest nonprofit health systems, opening our first hospital in 1927 Methodist Health System provides quality, integrated care to improve and save the lives of individuals and families throughout North Texas. Methodist Dallas Medical Center Methodist Charlton Medical Center, Methodist Mansfield Medical Center Methodist Richardson Medical Center Methodist Family Health Centers

Methodist Dallas Medical Center Methodist Dallas Medical Center is a 515-bed hospital located southwest of downtown Dallas. The medical center serves as the teaching and referral center for the Methodist Health System. Methodist Dallas’ services include cancer treatment, cardiology, emergency/trauma care, gastroenterology, general surgery, intensive care, neonatal intensive care, nephrology, neuro critical care, obstetrics and gynecology, orthopedics, rehabilitation services, pulmonology, radiology, transplantation, urology, and women’s services. Highlights First hospital in the nation awarded certification by The Joint Commission for pancreatic surgery Designated as a Level I Trauma Center Certified Stroke Center by The Joint Commission Opened Charles A. Sammons Tower in July 2014 248,000-square-foot trauma and critical care center New emergency department (ED) with 59 total patient rooms, including five trauma rooms and four triage rooms

DSRIP Projects Methodist Health System currently has 9 active DSRIP projects across 4 hospitals in RHPs 9 and 10 DSRIP Projects Charlton Dallas Mansfield Richardson Diabetes Management X ED Navigation Medical Home

Diabetes Project Summary Project Objective To develop and implement a chronic disease management intervention with the goals of improving effective management of chronic conditions and ultimately improving patient clinical indicators, health outcomes and quality, and reducing unnecessary acute and emergency care utilization. Project Goals Implement diabetes order set and clinical pathways Develop diabetes self management education program Train staff in Wagner Model/Chronic Care Model Form interdisciplinary team focused on diabetic patient care Target Population ED patients with a principal or secondary diagnosis of diabetes lacking knowledge of disease management Focus on diabetic ED patients identified as “high risk” based on clinical protocols of HbA1c > 9%, ED visits in past 12 months, and/or lack of diabetes education in last 5 years

Diabetes Project Summary Project Staffing for Methodist Dallas Health Center Care Management Director 2 ED Patient Navigators (RN & MSW) Services Provided Schedules and provides referrals for primary care provider appointments Provides individualized diabetes education Connects patient to group diabetes education Provide referrals for other community resources as needed Ensures that patients admitted from the ED have appropriate diabetes-specific order sets in place Periodic follow up (based on risk level) with patients 30 days post discharge

Almost 60,000 Emergency Department visits 13% are diabetic patients Methodist Dallas ED ED Diabetic Patient Statistics 48% Medicare 19% Self Pay Almost 60,000 Emergency Department visits 13% are diabetic patients 18% Other insurance 15% Medicaid Source: Dallas MHC DY2 DSRIP Baseline Data

Project Structure Based on Wagner Model (Chronic Care Model) Focuses on 3 essential elements of CCM: Self-Management Support, Delivery System Design and Decision Support Self-Management Support: Implementation of diabetes self management education (individual and group) Decision support: Diabetes pathways and order sets Delivery System Design: Interdisciplinary teams

High Level Project Workflow Navigator / ED staff identifies diabetic ED patient ED Navigator reviews patient chart ED Navigator determines patient’s level of risk ED Navigator meets with patient to discuss self management Patient receives education packet ED navigator uses MIDAS to document encounter ED navigator engages interdisciplinary team if needed and ensures appropriate care is given ED navigator provides PCP & DSME referral Outpatient DSME Follows up with patient as needed over next 30 days to ensure self management goals are met met

Risk Stratification Tool Level of intervention is dependent upon patient’s risk level

Anticipated Outcomes Decreased ED visits in targeted diabetes population Increased level of patient awareness of diabetes management Standing orders and clinical pathways for diabetic patients Form interdisciplinary teams for diabetic patient care Develop diabetes education program

Challenges Language barrier Surrounding area is over 50% Hispanic Lack of formal OP diabetes education program Patient participation in follow up care Connecting unfunded patients to PCP Providing patient education in Emergency Department environment Staff engagement and awareness of DSRIP project

Project Highlights 68 patients reached since Oct 2014 (135 total) Established Interdisciplinary teams Patient education on patient televisions Internal & External Partnerships Golden Cross Clinic Diabetes “Health Fairs” American Diabetes Association of North Texas Diabetes Workshops DFW Hospital Council Lenovo tablets Methodist ACO (Accountable Care Organization) Patient Referrals Pharmaceutical companies Free education materials and vouchers Metrocare Resources for behavioral health patients

Diabetes Education Golden Cross / DSRIP Health Fair participants listening to self management tips ADA Diabetes Educator teaching patients about healthy eating Healthy lunch for class participants

Next Steps Continuous Improvement – PDSA Cycles Spanish DSME Classes Standardized discharge kits Glucometer, strips, educational materials, etc. Increased physician engagement Primary care clinics for unfunded patients

Questions

Contacts Project Contacts Dallas Leslie Pierce Vice President Revenue Cycle 214-947-4583 LesliePierce@mhd.com Stacie Anderson DSRIP Project Manager 214-947-2521 StacieAnderson@mhd.com Kathleen Evans Director Care Management 214-947-2440 KathleenEvans@mhd.com Deondria Dickson Patient Navigator 214-933-7107 DeondriaDickson@mhd.com Diane Skaugen 214-933-7108 DianeSkaugen@mhd.com