p. 1

recommendations for the prevention identification and management of diabetes in the community nnn ambulatory care quality taskforce

[close]

p. 2

acqt members ron brown m.d karen cox joseph davison m.d ed dismuke m.d david gambino irene hermrick catherine holdeman shannon krysl lee meyer kevin nash craig r parman m.d jon rosell ph.d amy sanders kathy sexton sherrie string jenny thrush ron whiting family medicine specialists acqtco-chair providrs care network west wichita family medicine university of kansas school of medicine-wichita via christi health preferred health systems city of wichita acqtco-chair wichita public schools-usd 259 child start sedgwick county haysville family medical center medical society of sedgwick county youthville city of derby wbchcboardchair via christi health city of derby wichita business coalition on health care 2

[close]

p. 3

iabetes is a serious health issue impacting an increasing number of individuals the costs of diabetes are substantial both in terms of quality of life and financially however evidence shows there are effective strategies for preventing diabetes identifying it early and controlling the disease to minimize its impact what is clear from this evidence is the importance of all stakeholders working together the wichita business coalition on health care convened a multistakeholder taskforce representing physicians health plans hospitals and employers the group was charged with developing recommendations for the community regarding the prevention identification treatment and management of diabetes the purpose was to identify steps each stakeholder could take to improve the quality of care in the community based on the understanding that each had an important role in contributing to a higher standard of care these recommendations can provide a common set of expectations across all stakeholders for how each acts in order to minimize the impact of diabetes in our community some recommendations are simple while others or more complex and will require significant change by some or all stakeholders there are a tremendous number of resources available to provide further guidance and information about the standard of care for diabetics some of these are provided in appendix a 3

[close]

p. 4

contents 2 acqt committee members 3 introduction 5 recommendations for employees/patients/families 10 recommendations for physicians offices 15 recommendations for health plans/payers 21 recommendations for employer/worksite 26 recommendations for benefits design 31 appendix a signs and symptoms of diabetes 32 appendix b diabetes resources 33 appendix c proposed measures for aco quality-performance standards 34 appendix d about the wichita business coalition on health care

[close]

p. 5

recommendations for employees patients families fundamental responsibility for care lies with the employee/patient diabetes is significantly influenced by lifestyle factors such as nutrition and exercise the recommendations for patients include taking responsibility for health healthy behavior and self-management 5

[close]

p. 6

prevention 1 exercise regularly and eat healthy 2 have an identified primary care physician 3 understand the risk factors for diabetes and pre-diabetes signs and symptoms 6 employees

[close]

p. 7

hra/identification 1 complete a health risk assessment hra annually 2 complete biometrics e.g glucose body fat blood pressure lung capacity thyroid testing etc 3 review the hra with a health professional1 ideally a personal primary care physician 1 physician nurse practitioner physician assistant registered nurse certified diabetes educator 7 employees

[close]

p. 8

treatment and management 1 take responsibility for self-management 2 become educated about diabetes and effective self-management 3 request self-management resources from physician and other care-givers 8 employees

[close]

p. 9

measuring success 1 number/percentage of employees completing hra and biometrics 2 number of employees completing a visit to primary care physician within 60 days of completion of hra 9 employees

[close]

p. 10

recommendations for physician offices while the onus lies with the patient to take responsibility for his or her own health an effective relationship with a physician particularly a primary care physician can have a positive effect on an individual s health status physicians have a significant opportunity to engage with patients to support them in identifying risk factors providing important prompts to seek timely care and providing counseling and education about effective self-management 10

[close]

p. 11

prevention 1 physicians should be proactive in supporting messages of good nutrition and physical activity in our community physicians should support coordinated messages around these issues 2 identify pre-diabetic and metabolic syndrome patients and alert them to the signs/symptoms of diabetes 3 consider adopting quick screening tools for use during patient visits2 4 if not offered to the patient through their employer the physician should administer an hra or equivalent with each patient if they have not had one in the previous year 2 example bang et al annals of internal medicine dec 1 2009 vol 151 no 11 p 775-783 11 physicians

[close]

p. 12

hra/identification 1 emphasize the importance of identification of risk and early intervention for patients who may be at risk 2 schedule adequate time to allow initial counseling of patient regarding identification as pre-diabetic or diabetic 3 set the expectation within the practice that all pre-diabetics will receive counseling and education about diabetes and preventing further progression 4 establish and maintain a patient registry for diabetics within the practice 5 use the registry to ensure timely reminders for both physicians and patients regarding the standard of care for diabetes management 6 if electronic health record ehr is in place request vendor to re-educate office on tools of existing system to id and follow patients 7 review ncqa guidelines related to diabetic care and patient tracking3 3 http www.ncqa.org/tabid/1023/default.aspx 12 physicians

[close]

p. 13

1 establish office processes that automate implementation of clinical practice guidelines based on national standards e.g ncqa 2 reach out to diabetic patients in practice to engage in treatment plan and monitoring 3 use reminders to ensure both proactive communication to patients as well as reminders/prompts at the time of a physician office visit 4 use registries to provide proactive care and to enable use of reminders 5 provide patients with information about care standards/guidelines so that patients are aware of both their responsibility as a patient as well as what care they should expect to receive from their physician 6 set expectation that all physicians will participate in the wichita health information exchange to ensure connected care between clinical settings 13 physicians treatment and management

[close]

p. 14

1 physician offices actively using a patient registry for diabetes 2 measure diabetes care provided per ncqa guidelines 3 pqri data for diabetes care 4 percent of physicians using the wichita health information exchange whie 14 physicians measuring success

[close]

p. 15

recommendations for health plans payers health plans and payers play an important supporting role in facilitating patient engagement and providing information in a timely manner health plans often have access to data and information which can help in the identification and management of health conditions among members health plans have the ability to address alignment of financial incentives for both physicians and patients to encourage appropriate and timely action health plans also have the ability to work with employers to design and implement innovative benefit designs which reduce barriers to necessary care 15

[close]