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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Questions

17. Contacts Project Contacts Dallas Leslie Pierce
Vice President Revenue Cycle
Stacie Anderson
DSRIP Project Manager
Kathleen Evans
Director Care Management
Deondria Dickson
Patient Navigator
Diane Skaugen