Diabetes Quality of Care Project Joe Brisson VP Client Services Browsersoft, Inc.

Presentation Kansas Department of Health – Diabetes Quality of Care Project History Outcomes OpenHRE™ Toolkit Kansas Deployment Please recognize that the Diabetes Quality of Care Project existed for several years prior to the OpenHRE deployment. My role in this project was to act as the Program Manager for the past two years in deploying the OpenHRE software to automate the statewide diabetes registry developed through the efforts of the staff at the Kansas Department of Health – Specialty Studies.

Project Rationale: Public Health Impact 7.1% or 151,000 adult Kansans diagnosed with diabetes An estimated 65,000 Kansans have diabetes and don’t know it Almost 50% of the Kansans are at increased risk for diabetes because of risk factors of age, obesity and sedentary lifestyle More than 50% of Kansans with diagnosed diabetes are obese Children born in the year 2000 will face a 1 in 3 chance of developing diabetes at some time in their life Direct and indirect cost of diabetes is nearly $1.5 billion This data is the rationale for the Diabetes Quality of Care Project Source: 2006 Kansas Behavioral Risk Factor Surveillance System. Office of Health Promotion, KDHE. Diabetes. You could be at risk. Diabetes Detection Initiative. National Diabetes Education Program. Diabetes Prevention and Control Program. http://www.cdc.gov/diabetes/news/docs/lifetime.htm Economic cost of diabetes in the U.S in 2007 Centers for Disease Control and Preventions.

Kansas Diabetes Prevention & Control Program Objectives By 2008, increase the rate of: HbA1c test 69.1% to 83.0% Annual foot exam 60.8% to 83.0% Dilated eye exam 67.5% to 83.0% Recommended pneumococcal immunization 49.3% to 51.6% Recommended annual influenza immunization 60.7% to 63.5% Kansas Targets – CDC

Project Background Wichita Pilot Project 2002-2004 Spread Project Statewide 2004-Current Implemented in Stages (teams) Our Vision – Healthier Kansans living in safe and sustainable environments.

The Chronic Care Model The goal of the Model is to improve outcomes – that requires an informed activated patient working collaboratively with a proactive practice team

Project Components Diabetes Teams Regular Team Meetings Quarterly Reports Office Protocol Development Monthly Conference Calls Site Visits Chronic Disease Electronic Management System (CDEMS) The Chronic Care Model is the theoretical construct underlying this project. These are some of the processes that used to implement the Model. Our Vision – Healthier Kansans living in safe and sustainable environments.

Project Demographics 45 Funded Organizations 80 Sites Statewide 350+ Participating Health Professionals Diverse Organizations Our Vision – Healthier Kansans living in safe and sustainable environments.

Project Demographics Types of Participating Organizations Safety Net Clinics Local Health Departments American Indian Health Clinic Home Health Agencies Hospital Affiliated Practices Private Practices Farmworker Program Promotora Programs Our Vision – Healthier Kansans living in safe and sustainable environments.

Kansas Diabetes Quality of Care Project Sites Doniphan Brown Republic Washington Marshall Nemaha Cheyenne Rawlins Decatur Norton Phillips Smith Jewell Atchison Pottawatomie Cloud Leavenworth Riley Jackson Clay Sherman Thomas Sheridan Graham Rooks Osborne Mitchell Jefferson Geary Ottawa Lincoln Shawnee Waubaunsee Dickinson Douglas Johnson Wallace Logan Gove Trego Ellis Russell Saline Ellsworth Morris Osage Franklin Rush Miami Greeley Wichita Scott Lane Ness McPher- Barton Pawnee Rice son Marion Lyon Chase Coffey Anderson Linn Hodgeman Stafford Harvey Stafford Hamilton Kearney Finney Wood- Edwards Reno Reno son Allen Bourbon Greenwood Pratt Sedgwick Butler Gray Ford Kiowa Kingman Stanton Grant Haskell Wilson Neosho Crawford Elk Mont- Morton Stevens Seward Meade Clark Comanche Barber Harper Sumner Cowley Chautauqua gomery Labette Cherokee Our Vision – Healthier Kansans living in safe and sustainable environments.

Data Collection Tool Chronic Disease Electronic Management System Implementation (CDEMS) Our Vision – Healthier Kansans living in safe and sustainable environments.

CDEMS How does it work? Hard copy inserted into patient’s chart Patient Data Entered Hard copy inserted into patient’s chart % of Patients Receiving Vaccinations and Foot Exams Needs Improvement Dr. updates patient’s chart Many organizations have automated the data entry process through an interface to their practice management systems. Some organizations have automated the data entry of their lab results through interfaces. Our Vision – Healthier Kansans living in safe and sustainable environments.

Quality Improvement Targets Processes Self Monitoring BG Diabetes Ed Nutrition Ed Self-Mgmt Goals Smoke Cessation BMI Calculated BP Checked Pt. Visit Compliance Outcomes Eye Exams Pneumo Vaccination Flu Vaccination HbA1c Tests Done Foot checks

Improved Clinical Processes (All Project Clinics) Percent of Total Patient Registry 2005 2008 Source: 2005-2008 CDEMS Aggregate Data

Improved Clinical Processes (All Project Clinics) Percent of Total Patient Registry 2005 2008 Source: 2005-2008 CDEMS Aggregate Data

Improved Clinical Processes: Patient Office Visits (All Project Clinics) Percent of Total Patient Registry 2005 2008 Source: 2005-2008 CDEMS Aggregate Data

Improved Quality of Care Outcomes (All Project Clinics) Percent of Total Patient Registry 2005 2008 Source: 2005-2008 CDEMS Aggregate Data

Data Translated Into Practice - at the clinic level New office protocols in all organizations Diabetes patient newsletters Patient certificates for improved A1c Pre-visit patient self-assessment programs CDEMS data used to guide team decisions Improved communication among providers Separate diabetes clinic days established Patients made full partners in care Our Vision – Healthier Kansans living in safe and sustainable environments.

Office Protocols Implemented Physicians Required to Review self-mgt. Goals at each patient visit Exercise (Xs per week) recorded in each patient chart Obtain/Record dental & eye exam dates Socks/Shoe removal prior to physician exam Our Vision – Healthier Kansans living in safe and sustainable environments.

Office Protocols Implemented Patient required to fill out self-mgt. goal sheet at each visit Self-monitoring homework sheets sent home with patients RX refill-if last pt visit >3 months then meds only refilled for one month All providers required to use CDEMS Summary Sheets Our Vision – Healthier Kansans living in safe and sustainable environments.

Data Translated Into Practice - at the community level Pre-Diabetes Screening Programs Community health fairs Churches Cattle and hog processing plants New Community Partnerships YMCA Podiatrists Optometrists Dentists Community Diabetes Education Programs Targeting seniors Targeting overweight/obese Our Vision – Healthier Kansans living in safe and sustainable environments.

CDEMS Data Collection Process Data Exported Into MS Excel Excel Spreadsheet Emailed to KDHE Patient Data Entered in CDEMS Clinic See reports Protocol development Systems change – changing the way care is provided KDHE Staff Put Data Into Master Excel Spreadsheet For Analysis

OpenHRE™ Method of data collection was not efficient Accuracy of information obtained was affected due to inconsistent data collection and submission

What is OpenHRE? The OpenHRE™ Toolkit is a flexible solution for constructing, maintaining and scaling Health Information Exchanges.   Core services of the Toolkit securely connect stakeholder systems, apply patient and community preferences for locating records, authenticates users, retrieve and present aggregated or individual patient records Download the OpenHRE™ Toolkit at: SourceForge.net

Data Extraction Process Original 13 pilot sites Client Application remove directly identifiable patient data, pushes data to KDHE twice monthly Over 40 clinics currently in production Our Vision – Healthier Kansans living in safe and sustainable environments.

Data Query Process Co-located replicated databases (directly identifiable patient data removed) CDEMS adapter – translate data into the reporting database Mondrian – open source Online Analytical Processing Tool for Slicing and Dicing the data Diabetes Summary Report online tool for displaying the data by clinic(s), by county(ies), other combinations.

Contact Information: Joe Brisson VP Client Services Browsersoft, Inc. (913) 851-2453 JoeB@browsersoft.com Our Vision – Healthier Kansans living in safe and sustainable environments.