Next Steps Robert A. Gabbay, MD, PhD Professor of Medicine, Penn State College of Medicine

Until we meet again… Use your practice facilitator as a resource Meet with and call Patty/Sharon: Pick a date today! Reflect on and respond to their feedback Continue (or start) holding weekly team meetings Develop a plan to collect any data you don’t have or correct any data you know is wrong Continue implementing: Population alert Use of template/flow sheet with embedded guidelines Standing orders Planned care at every visit

Until we meet again… Start testing self-management support Patient report cards Collaborative goal setting Think about risk assessment and follow-up interventions for varying levels of risk Frequency of visits Follow-up phone calls Clinical protocols Identify diabetes patients overdue for visits and reach out to them to schedule a visit and provide follow-up care

Until we meet again… Show significant and sustained improvement in at least 1 outcome measure and 3 process measures Keep on reporting PDSAs, data, status reports Participate in webinars: 4th Thursday of month (except for Nov and Dec), 12pm-1pm Sept. 27 ▪ Oct. 25 Nov. 15 ▪ Dec. 20 Tell us what you need!

Monthly Report Due Dates 2012 2013 October 5 November 5 December 5 January 7 February 5 March 5 April 5 May 6 June 5

Learning Session #3 South Central Northwest Jan. 29: 5-9pm at PSU College of Medicine, Hershey Northwest Jan. 22: 5-9pm at PSU Behrend, Erie

Practice Facilitators Northwest Patricia J. Stubber, MBA Executive Director Northwest PA AHEC 8425 Peach Street Erie, PA 16509-4788 814-217-6029 (phone) 814-594-4740 (cell) 814-864-4077 (fax) pstubber@nwpaahec.org South Central Sharon M. Adams RN, BA Executive Director Southcentral PA AHEC PO Box 509 Carrolltown, PA 15722 814-344-2222 (phone) 814-344-2221 (fax) sadams@scpa-ahec.org Web: www.paspread.com Email: paspread@hmc.psu.edu