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

2. 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.
Identify diabetes patients overdue for visits and reach out to them to schedule a visit and provide follow-up care.

3. Until we meet again…
Continue implementing critical changes on monthly reporting form.
Population alert
Template/flow sheet
Standing orders
Huddles
Planned care at every visit
Patient report cards
Patient self-mgmt goals
Risk assessment at every visit
Follow-up care for high-risk

4. Until we meet again… ▪ March 28
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: 12pm-1pm
Feb. 21
▪ March 28
April date tba
Tell us what you need!

5. Monthly Report Due Dates
February 5
March 5
April 5
May 6
June 5

6. Learning Session #4 South Central Northwest
May 9: 5-9pm at PSU College of Medicine, Hershey
Northwest
May 16: 5-9pm at Cross Creek Resort, Titusville

7. Practice Facilitators
Northwest
Patricia J. Stubber, MBA
Executive Director
Northwest PA AHEC
8425 Peach Street
Erie, PA
(phone)
(cell)
(fax)
South Central
Sharon M. Adams RN, BA
Executive Director
Southcentral PA AHEC
PO Box 509
Carrolltown, PA 15722
(phone)
(fax)
Web: