Diabetes. Evidence Based/ Team Based Care in a Community Health Center ---

Transcription

1 Diabetes Evidence Based/ Team Based Care in a Community Health Center --- Sharon Mulvehill MD North Texas Area Community Health Center August 23, 2014

2 The Challenges Busy schedules, little time for system design. Most clinic visits are illness visits, most patients have multiple diagnoses and needs. Providers want to deliver excellent health care but are challenged by many things to consider at each patient visit. Visit notes - difficult to extract data for peer review, CQI, ongoing care.

3 More Challenges Many underserved patients are not aware of recommended preventive health services. Health care systems often focus on productivity, providers may fear increased preventive health care delivery may decrease efficiency. New staff, new graduates, more mature staff less enthusiastic about new projects/more work. Disease of the month - many demands on providers.

4 Goals Identify core data (list) to track for diabetes patients and available methods to get it done Learn team care principles to enable preventive health care and diabetes care at each patient visit for a diabetic patient. Understand advantages of documenting care in EMR clinical guidelines Learn how a patient registry can help.

5 Why use a list Prior medical practices - stable, long term, less financial pressure, more expert opinion. Current practices - evidence based guidelines that decrease morbidity and mortality, more mobile providers, more mobile patients, efficiency driven, increased focus on outcomes and transparency.

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7 Lessons from Aviation Both are complex industries, people s lives are at stake, highly trained professionals must work together. Aviation has long been a proponent of checklists to help with regular safety checks and emergency procedures. Adapted in medicine to surgical safety and infection prevention (hospital); now application to clinic.

8 Why team based care? Individual practice can t get it all done - there is just too much to do. Allowing other team members to work to their full extent gives patients more care. More fun, less exhausting for providers. Engages the patient/family as part of the team.

9 More from Aviation Prior culture - captains were gods or cowboys in determining how things ran in the cockpit. Crew members who spoke to the captain about unsafe practices were placing their job on the line. - Sullenberger, Captain US Airways Flight 1549 New crew resource management - allows other members to bring up problems to the captain, collaborative decision making.

10 EMR Care Guidelines Track care items in a separate area, outside of traditional visit notes. Reminds team when and what care is due. Stores prior preventive health care services so they are not duplicated. Available for reporting, peer review, CQI projects.

11 Patient registries Allows diabetes team to case manage patients more easily Promotes data sharing among the team Fosters managing patient panels properly (size, patient access, outcomes) Helps give the team ownership of their panel

12 Getting Started The Chronic Disease Model Start with educated providers and patients. ADA, AACE, TDC guidelines all online and available. ADA has ENORMOUS amount of CME available.

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16 NCQA measures HgbA1c Blood Pressure LDL Eye exam Foot exam Nephropathy Tobacco

17 Visit One

18 Visit Two

19 Visit Three Finish Flow Sheet

20 Where is Health Maintenance Tdap, pneumovax Pap, gardisel, contraception mgmt Mammogram, colorectal screening, dexa scan

21 Care Guidelines Start with Health Maintenance. Complete one or two services each visit. Address at every visit. Tdap/pneumovax and FIT (CRS) are an easy place to start.

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23 Add Diabetes Care Guidelines Evidence based at point of care - CDC, USPTF Tracks completed lipids, a1c, urine microalbumin, Fit test, diabetic foot exam. Manually update mammogram, eye exam. Reminds EVERYONE entering record if care items are due and which ones. Team based care. Show what a great job you do!

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27 The Future Texas Diabetes Council - get involved Take students - you have to know it to teach it Group visits - peer support, education, md care Kiosk for patient portal access - web enable all diabetics Aim-Hi - group weight management designed by AAFP Monthly diabetes conference with endocrinologist

28 How to Get Started Find someone with a passion for problem solving. Need someone with an interest in the EMR. Start with a PDSA Tag you re it Call me, I ll help.

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