1. GO! Diabetes Train the Trainer Program

2. Practice Performance and Improvement

3. Diabetes Master Clinician Program A quality assurance program that--- Promotes excellence in diabetes care Empowers Patients, Staff and Clinicians to achieve the best possible care Removes BLAME—throws out the word compliance and states that recognizing and overcoming barriers is the key to success Addresses Clinician Barriers, Patient Barriers, Staff Barriers and System Barriers

4. Care that is Safe Effective Efficient Equitable Patient-centered Timely Evidenced-based Institute of Medicine Crossing the Quality Chasm

5. How good is our Health Care In the past two decades US health care has gone from being a source of National Pride to one of America’s pre-eminent concerns” Porter and Teisberg “The US spends more on health care than any other industrialized nation ($5000 per person vs. $1500) but ranks at the bottom on standard measures of quality and health status” Commonwealth report and Steve Schroeder “We have a large gap-chasm between the health care we have and the health care we could have” Institute of Medicine

6. What is the problem with our Health Care System? It is not that Clinicians do not care Our system of education and care designed for failure Working hard but are we working smart? “A significant part of the Quality problem in Health care is surprising and counterintuitive-Performance is rarely Measured” Donald Berwick MD CEO Institute of Health Care Improvement “Mandatory measurement and reporting of results is the single most important step in reforming health care” Porter and Teisberg

7. Diabetes as a Model for Reform Nationally many patients not receiving adequate care Reaching ADA goals?? 48% reach HbA1c <7%, 33% reach LDL <100 and B/P < 130/80—7% all three Excellent evidence (DCCT & UKPDS) that reducing HbA1c 1% ↓ blindness, renal disease and neuropathy 33% Reaching goal for LDL and B/P ↓ MI and stroke 30 to 40% Significant Cost Savings when goals are reached

8. Towers Perrin Actuarial Evaluation 2006 Bridges to Excellence ADA Quality IndicatorYearly Cost Savings if indicator achieved HBA1C ≤ 7 $279.00 LDL ≤ 100 $369.00 Syst BP ≤ 130$494.00 Total yearly savings$1122.00 http://www.bridgestoexcellence.org/assets/ Documents/Program_Evaluation_Documents/DCL_analysis1207051.pdf http://www.bridgestoexcellence.org/assets/ Documents/Program_Evaluation_Documents/DCL_analysis1207051.pdf

9. The DMCP Diabetes Registry Internet-Based system sponsored by the Florida Academy of Family Physicians Foundation Measures achievement of evidenced-based guidelines from the ADA, NCEP, JNC7 Driven by Family Physician Users Produces reports to aid achievement of excellence in diabetes care.

10. September 2008

11. March 2009

12. That was then…this is now… ValuesAll ClinicsStart 9/08Now 3/09 Weight211228 BMI343938 BP132/77144/80138/80 A1C7.38.18.2 Total cholesterol179168170 LDL1009490 HDL454144 Triglycerides174165184

13. That was then…this is now… ValuesAll ClinicsStart 9/08Now 3/09 Group visits3%0%9% Eye exams19%22%33% Foot exams31%16%42% Microalbumin28%16%49% Pneumovax30%0%39% Flu vaccine19%32%38% Aspirin use47%29%33%

14. Floyd Savings – March 2009 for DMCP Using Towers Perrin Data Quality Indicator (# Pts reaching goal over national average) Cost Savings HBA1C -(32)- ($8,928.00) LDL (90) $33,210.00 Syst BP (9) $4,446.00 Total savings in 1 Year$28,728.00 http://www.bridgestoexcellence.org/assets/Documents/Program_Evaluation_Documents/DCL_analysis1207051.pdf

15. The DMCP Diabetes Registry What are some possible strategies to improve excellence in diabetes care?

16. Diabetes Change Agents Utilize the diabetes registry report card with every patient with diabetes Develop a team system to encourage accountability Standing protocol orders for staff to implement

17. 1.MA gave patients and physicians report cards 2.MA did the monofilament exams 3.MA ordered tests per protocol Impact of Medical Assistants Over 8 month Period in 140 Patients

18. Diabetes Change Agents: Three Month Goal – July 1, 2009 Blood Pressure -Actively manage hypertension at every visit with a goal of <130/80 -Goal of 50% of patients blood pressure <130/80 Aspirin -Recommend all patients with diabetes to take an 81mg ASA daily, unless contraindicated -Document aspirin use on medication list for 50% of patients

19. METRIC Metric stands for Measuring, Evaluating, and Translating Research Into Care. It is an innovative online practice improvement program where you will input records of 10 diabetic patients prior to today and again within 90 days. www.aafp.org/metric

20. METRIC 16 practice change options are offered as a choice for the METRIC participants In 2009, the top three choices were (participants may choose more than one intervention): 1. Putting guidelines into practice 2. Incorporate flow sheets into practice 3. Build a patient registry

21. Practice Changes METRIC results showed some changes in patient care over the 90 days The GO! Diabetes project baseline data was tabulated from data entered by 512 physicians from 4,609 diabetic patient charts seen in their clinics in May, June and July. The two control groups entered data from 104 patient charts.

22. Practice Changes METRIC results showed some changes in patient care over the 90 days The follow up data was collected 90 days later and as of the end of December 2009, 1,503 patient charts had been entered by the GO! Diabetes participants and 102 charts by the two control groups from patients seen in their clinics in August, September and October 2009.

23. Practice Changes Analysis of the data after the 90 day practice improvement implementation showed the number of patients meeting treatment goals increased in the following areas: A1C Total Cholesterol LDL Documentation of Eye and Foot Exams Documentation of Flu Vaccination Recommendations for ASA Therapy

24. Practice Changes Percent of patients’ clinical measures meeting treatment goals that did not change were: HDL Triglycerides Systolic and diastolic BP