1. Hemoglobin A1c Clinic Improving Diabetes Care Patti Wascom, FNP, CDE Ashley Waggoner, PA Jane Whitney, RN, BSN Joanne Paige, LPN

2. Louisiana Highest Diabetes mortality rate in the nation (35.5 / 100,000) persons Cost of Diabetes care in 2007 $2.43 billion dollars Diabetes Prevention and Control Program-2007 Diabetes Report. Louisiana Department of Health and Hospitals.

3. Identified Need at BMC Diabetes Disease Management Quarterly Report Monthly A1c reports generated by lab

4. We Have a Problem! Average 228 A1c drawn monthly Average 40 A1c > 10% monthly A1c Clinic Proposed

5. A1c Clinic Began July 2009 4 hour weekly clinic Staff Mid-level provider RN LPN 347 scheduled-132 attended Average visits per patient- 2.3

6. High Risk Patients Average A1c 11.5% 36% documented A1c >10% more than 1 year 39% positive microalbumin

7. Clinic Structure Initial visit Follow-up at 2-8-12 weeks Referrals Ophthalmology Formal Diabetes Education Diabetic Support Group TLC (weight management) Endocrinology Psychology Repeat A1c- if at goal Discharge

8. A1c Clinic Content Purpose Review current knowledge Review current treatment plan Patient Agreement Appropriate modifications Education

9. Principals Office Initial Evaluation Identify Barriers Financial Psychological Social Physical

10. A1c Achievement Percentages Baseline 11.3%

11. Conclusion Patients with improved glucose control Reduced risk of mortality Improved quality of life Reduced financial burden