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Improving Care for Diabetes
Improving Care for Diabetes
| Improving
Care for Diabetes
Promoting
more effective treatment
for diabetes often
involves developing
programs to educate
providers and patients.
Some examples:
- Health
Services Advisory
Group, Inc.,
the Arizona QIO,
worked with six Medicare
managed care organizations
to improve outpatient
diabetes management
by providing comparative
feedback of baseline
data. The results:
mean glucose levels
fell from 8.9 to
7.9; the proportion
of patients with
glucose levels below
8.0 rose from 40%
to 61.6%; the proportion
of indicated services
provided to patients
rose from 35% to
55%; the mean number
of physician office
visits fell 13% while
the number of services
provided per visit
doubled.
- QSource
worked with the state
diabetes education
program, physician
offices, and community
partners to increase
the awareness of
diabetes preventative
care services for
the Medicare population.
QSource conducted
regional educational
workshops, targeted
state medical associations,
developed consumer
awareness campaigns,
distributed 60+ community-based
toolkits and participated
in statewide forum
for diabetes care
sponsored by the
governor's office.
These efforts resulted
in an absolute improvement
of 12% for A1C testing,
and a 23% absolute
improvement in lipid
profile rates. For
more information,
contact Raymond Dawson,
901-273-2608.
- Qualis
Health, the QIO
for Washington, Alaska
and Idaho, worked
with the Washington
State Department
of Health, the Group
Health Cooperative
of Puget Sound and
more than 30 clinics
across the state
to implement the
Washington State
Diabetes Collaborative.
Participating clinics
chose different process
and outcomes measures
to focus on, and
shared their successes
in regular "learning
sessions." Measurable
improvements have
been noted in the
rate of foot exams,
blood sugar testing,
and in levels of
LDL cholesterol in
patients with diabetes.
- Primaris
enrolled select physician
offices in the state’s
first Diabetes Collaborative,
using a model specifying
essential elements
of diabetes care.
As a result, patients
of these practices
meeting the national
goal of two hemoglobin
A1c tests per year
rose 397%; and by
September 2002, 520
patients were enrolled
in active care registries.
These clinics are
now applying clinical
lessons learned to
other chronic diseases.
Using statewide and
regional partnerships,
Primaris also
reached almost 10,000
Missouri physicians
with guidelines and
systems change tools.
Compared to two years
earlier, 12,612 more
Medicare beneficiaries
with diabetes received
a biennial lipid
profile, 9,474 received
an annual A1c, and
6,423 a biennial
eye exam statewide.
- Health
Care Excel, the
Indiana QIO, conducted
a project with selected
Indiana nursing homes
to determine how
to improve care for
people with diabetes.
Data were obtained
at three intervals
to assess the level
of care among beneficiaries
with diabetes in
nursing homes by
measuring the number
of beneficiaries
who received hemoglobin
A1C (HbA1c) testing.
Interventions for
the project were
developed by an interdisciplinary
Medicare QIO diabetes
workgroup and included
continuous quality
improvement education,
diabetes education,
and development of
policies and procedures
for diabetes care
in nursing homes.
The data revealed
an increase in administering
the HbA1c test 56.7%
to 86.6%. Rates were
sustained at 81.2%.
In addition to a
higher rate of HbA1c
testing in the intervention
group, the data displayed
an unexpected trend
in positive outcomes,
demonstrated by lower
levels of HbA1c test
results.
- North
Dakota Health Care
Review, Inc.,
the North Dakota
QIO, collaborated
with clinics that
provide care to more
than 60% of the state’s
diabetic population.
Five years of implementing
system improvements
such as a diabetes
care flow sheet have
led to statistically
significant increases
in the project’s
five quality indicators:
semi-annual office
visits, annual hemoglobin
A1c rates, eye exams,
urinalysis, and measurement
of microalbumins.
The QIO also has
developed a system
widely used by providers
in the state that
facilitates tracking
of the health status
of diabetics and
includes a patient
reminder system for
routine diabetes
standards of care
such as HbA1c, dilated
eye exams, and lipid
testing.
- Acumentra Health,
the Oregon QIO, worked
with five Medicare
managed care organizations
to improve screening
rates and outcomes
for patients with
diabetes. The result:
significant increases
over a three-year
period in dilated
eye exams (16%),
glucose testing (14%),
patients with improved
glucose control (13%),
and patients with
tight blood pressure
control (5%).
- Quality
Partners of Rhode Island
developed a task
force to increase
the number of dually
enrolled beneficiaries
with diabetes who
have a biennial lipid
test. The task force
designed interventions
for both providers
and dually enrolled
beneficiaries. Physician-targeted
interventions included
audit and feedback,
site visits, and
clinical information
to address the knowledge
deficit regarding
the critical link
between diabetes
and cardiovascular
disease. Dually enrolled
beneficiaries received
a direct mailing
with messages to
talk to their doctor
about having a lipid
test. In addition,
the task force coordinated
a statewide diabetes
campaign targeting
the dually enrolled
beneficiary audience
as well as the general
population. These
interventions helped
increase the statewide
rate of lipid testing
from 46.8% to 73.6%.
Also, the disparity
in lipid testing
between dually enrolled
and non-dually enrolled
beneficiaries fell
from 10.7% to 3.4%,
representing a gap
reduction of 7.3%.
- Virginia
Health Quality Center,
the Virginia QIO,
used a variety of
interventions to
boost eye exams among
Medicare beneficiaries
with diabetes, such
as direct mailings
and follow-up reminders
to beneficiaries,
and mailings to physicians,
media campaigns,
and collaborations
with community organizations.
The results showed
an increase in eye
exams for the intervention
group, while no such
change occurred in
the control group.
The greatest increases
in eye exams directly
correlated with the
timing of interventions.
- The
Kansas Foundation
for Medical Care,
the Kansas QIO, conducted
a program to improve
office management
of diabetes services.
In visits with 319
physician offices,
KFMC discovered that
only 29% were utilizing
standardized systems
to assure that patients
were receiving HbA1c
tests, lipid profile
measurements, and
routine eye exams.
KFMC combined this
program with a continuing
education program
for nurses, and 117
offices took advantage
of the educational
opportunity. In response
to these efforts,
54 offices adopted
flow sheets to improve
care for their patients
with diabetes.
- Carolinas Center for Medical Excellence. implemented
a three-pronged approach
to improve care for
Medicare beneficiaries
with diabetes: physician-,
patient-, and community-level
interventions. Physician-level
interventions included
interactive teleconferences
with national- and
state-recognized
experts, targeted
medical and professional
association media
activities, statewide
partnerships, and
multiple direct mailings
of clinical tools
and performance rates.
Multiple direct mailings
for patient education
and awareness were
among the patient-level
interventions. The
community-level activities
consisted of health-related
news articles and
editorials in major
and local newspapers
across the state.
The result: absolute
improvements of 21.1%
in lipid profiles
(from 53.4% to 74.5%);
11.1% improvement
in A1C testing (from
69.8% to 80.9%),
and 2.3% improvement
for dilated eye exams
(from 69.6% to 71.9%).
- New
Mexico Medical Review
Association played
an integral role
in a joint initiative
of the American Association
of Health Plans and
the American Diabetes
Association involving
over 200 health plans
in Albuquerque, NM.
As the first of three
sites to pilot a
community partnership
to address diabetes
concerns, this effort
involved participating
plans jointly creating
and endorsing guidelines
based on ADA recommendations
for distribution
to providers throughout
the state.
- Stratis
Health joined
forces with eye health
organizations in
Minnesota on a consumer
campaign to mail
reminders and promote
the importance of
annual eye exams
for persons with
diabetes. In addition,
Stratis Health offered
clinics an Eye Exam
Reporting Form, a
tool to help facilitate
the reporting of
eye exam results
from the eye care
provider to the primary
care provider. During
the SOW6, Minnesota’s
biennial eye exam
rate went from 75.0%
to 79.0%.
- Information
and Quality Healthcare
successfully
recruited 193 providers
in Mississippi to
collaborate in its
diabetes project.
Providers were encouraged
to implement permanent
systems changes to
better manage patients.
Diabetes awareness
messages were distributed
to beneficiaries
through education
programs and health
fairs during the
initiative. In addition,
physician-provider
champions educated
colleagues, stressing
the need for emphasis
on the quality indicators,
a strategy that resulted
in increased diabetes
indicator rates.
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