1. The Practice Education and Enhancement Project in Diabetes Mellitus
A PEEP Into Practice: A Win-Win Education and Quality Improvement Project With Community Preceptors
The Practice Education and Enhancement Project in Diabetes Mellitus
Caryl Heaton, DO
Robin Schroeder, MD
Chantal Brazaeu, MD
New Jersey Medical School - UMDNJ

2. PEEP-DM Goals of this presentation 1) Describe the program
2) Describe introduction to preceptors
3) Describe the results so far
4) Give suggestions for reproducing this program

3. The Patient Centered Medical Home
“Quality and safety are hallmarks of the medical home: Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement”*.
However quality and safety were not a major concern in residency teaching that took place over about five years ago. *

4. Our Goal to teach quality assessment and improvement to students
simultaneously support (give back to) preceptors in advancing their QI efforts and help with ABFM requirements

5. The PEEP DM Project Student Introduction and Instructions
Data Gathering and Entering
Students gather data on 10 patients
Enter the results in Web CT
Results and QI Discussion
Results to Preceptor Faculty

6. Top half of Indicator sheet

7. Bottom Half of Indicator sheet

8. Collecting the Data
Each student “interviews” 10 diabetic patients and reviews the chart (NCR paper form)
No patient identification information is transmitted to the school
Copy of form is kept by preceptor
Student enters patient indicator data via WebCT
Transferred to Excel for statistical analysis
Will use SPSS in the future

10. Results/QI Seminar

11. It has become a little more focused and organized
Note the practice ID numbers and the student names
Ask that they keep the names confidential (or should we obscure them in some way?)

12. PEEP Results – CFM07-1 167 patients entered Average HgA1c = 7.51
For diabetic patients seen in teaching practices….
167 patients entered
Average HgA1c = 7.51
Average LDL = 112
Average BP = 133/81
Notice that the numbers are pretty good, but that we only had 167 and we should have had 220
One student who had ten patients has now put them in…

13. Reporting “by patient report”
% of patients that had
HgA1C in last 6 months
Feet checked in last 6 months
Urine checked in last year
Smoke
Had been advised to quit
Eye exam in last year
Cholesterol checked in last year
Blood pressure checked
Do you know your target BP?
89%
80%
74%
23%
86%
95%
100%
70%

14. Reporting – “by chart review”
88%
43%
73%
69%
93%
47%
100%
36%
56%
% of patients that had
HgA1C done in last 6 months
HgA1C less that 9,
and less than
Feet checked in last 6 months
Had check for albuminuria
Told to quit smoking
Eye exam report charted in last year-
LDL checked in the last year
Had an LDL ≤
Had their blood pressure checked------
Had a systolic ≤ 130, diastolic ≤80
You can decide how or what you want to highlight in this slide

15. Other Results HgbA1C 89% vs 88% Feet Check 80% vs 73%
Patient vs Chart
HgbA1C % vs 88%
Feet Check % vs 73%
Cholesterol/LDL 95% vs 100%
Eye Exam 74% vs 47%
So we ask them what they think of this and then we ask them what they think the percent of having all four of these where they should be

16. How many had all of these measures at target?
BP Sys, BP Dias, LDL, HgA1C
4.2%

17. Intervention Grid Provided at the debrief session Examples are given
Data collected about what students observe in practices

19. Compare your Office What was your office especially good at?
What techniques seemed to work in your office?
What things could be done better?

20. Foot Exam stickers for chart

21. Posters for the Wall

22. Diabetic Dilated Eye Exam Fax Back Report

24. Patient Education Sheet

25. Patient Self Assessment Tool

26. Next Steps: Compare results between practices
Using data from the intervention sheet (student report) we will try to identify activities that are associated with better outcomes
Feedback to preceptors….

27. Questions?