Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 “Diabetes Days” A Practice Efficiency Strategy Improving Diabetes Mellitus Patient Care Delivery & Outcomes.

Similar presentations


Presentation on theme: "1 “Diabetes Days” A Practice Efficiency Strategy Improving Diabetes Mellitus Patient Care Delivery & Outcomes."— Presentation transcript:

1 1 “Diabetes Days” A Practice Efficiency Strategy Improving Diabetes Mellitus Patient Care Delivery & Outcomes

2 2

3 3 Today’s Objectives Discuss Application of Care Change Concepts in Primary Care Review Planned Recall Strategy Review Batching Strategy: Diabetes Days “101” Discuss Sample Schedule and Tools Assess Best Practices for Implementation Determine Measures for Effectiveness

4 4 INTRODUCTION AND CONTEXT 10 minutes Introductions and Program Overview IMPROVING DIABETES CARE DELIVERY AND OUTCOMES 5 minutesCare Change Concepts 5 minutesCase Study 5 minutesPlanned Recall and Batching Strategies 20 minutesDiabetes Days 10 Steps 5 minutesMonitoring Quality Improvement 10 minutesWRAP UP AND MEASURE EFFECTIVENESS Today’s Agenda

5 5 The Challenge: Diabetes a complicated, growing disease: Incidence and prevalence of diabetes in Canada continue to increase1 Control is not improving: 50% of Type 2 Diabetes patients in Canada are not meeting their blood glucose targets 2 Implications and burden for primary care practice: Over 80% of type 2 diabetes patients will be under the care of their Family Physician with an average of 8 visits per year2 What is the solution? Governments & CDA promoting interdisciplinary team approach & enablers MD, RN, NP, Diabetes Educators, Pharmacists, Family Health Teams and Primary Care Networks Flow-sheets, registries, incentives etc…. Informed & empowered patients Diabetes Care in Family Practice 1. Canadian Diabetes Association. 2. Harris SB, et al. Diabetes Res Clin Pract 2005; 70:90-7. Teams require practical, implementable approaches to care delivery

6 6 Therapeutic Goals CDA Guidelines: 1 Goal of treatment is to minimize the risks of the macrovascular and microvascular complications of diabetes by aiming for the following metabolic targets: Ontario Ministry of Health: Quality Targets for Primary Care Physicians: Example: 2 1.The Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada., Can J Diabetes. 2008;32(suppl 1):S1-S201 2.Ontario Ministry of Health- Quality Targets for Primary Care Physicians:

7 7 Systematic Approach to Diabetes Care CDA Guidelines Recommendations CDA 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, Can J Diabetes. 2008;32(suppl 1):S1-S201 Teams require practical, implementable approaches to care delivery

8 8 PROGRAM OVERVIEW TODAY’S TOPIC

9 9 Principles of Access Optimize the Care Team Ensure that all members of the team are full scope of practice Physicians must educate patients so that patients understand the team approach Care Delivery Model (Who Does the Work) 1 Identify the roles of the healthcare team, as well as the process for providing care and advice to patients using agreed upon guidelines Identify and Manage the Constraint Use standardized guidelines and protocols to increase care that can be provided in alternate ways 1. Office Practice Redesign in Primary Healthcare: Access and Efficiency Workbook, 2011 Quality Improvement and Innovation Partnership p. 7www.qiip.ca

10 10 Care Change Concepts 2 Delivery System Design Define roles and delegate tasks among team members Use planned proactive visits to support evidence-based care Build “effective” care management functionality into practice Assure continuity by the primary healthcare team Ensure regular follow-up Health Care Organization Use effective improvement strategies for comprehensive system change Information Systems Include clinically useful and timely information on patients in registry Identify relevant patient subgroups and provide proactive care 2. Office Practice Redesign in Primary Healthcare: Access and Efficiency Workbook, 2011 Quality Improvement and Innovation Partnership Appendix, 38www.qiip.ca

11 11 Family Practice: Case Study Hamilton Family Health Teams – first wave FHT Aging patient population Focus on timely access to appropriate care, chronic disease prevention and management Practice advantage: inter-professional practice team –Physician, 2 RN’s, Part time DNE, medical student –2500 rostered patients –Preventative care, advanced access and after hours care Balance between acute and preventative care needed Inter-professional support and incentives existed but process required to manage population of patients with Diabetes… “The How”

12 12 Planned Recall URL:

13 13 “Diabetes Days” Planned recall: patient “batching” strategy Goal to provide efficient, effective DM focused visits Leverage expertise of inter-professionals clinic team Optimize “Work Flow” Improve practice efficiency, effectiveness, patient health outcomes Scheduling strategy allows for –Preventative care appointments –Advanced Access appointments –Joint scheduling (Physician, RN, DNE, Dietitian)

14 14 The Solution: Diabetes Days 10 Steps

15 15 Set up a DM Patient Registry Paper or Electronic Screen for patients using e.g. A1C >7%, LDL >mmol/L, BP >130/80 Hg etc Allows you to know who your patients are and track their visits and progress See Practice Guide Page “DIABETES DAYS” STEP 1

16 16 Staff Alignment Team Alignment is critical: Alignment should anchor to benefits diabetes days approach can make to patients and providers Ensures each team member’s contribution is leveraged Coordinate around staff availability (RN, DNE) Standardize visits supported with agreed upon protocols, roles Standardized tools and materials agreed upon: EMR, Stamps, Flow Sheet, Diabetes Education Kit and Patient Materials “DIABETES DAYS” STEP 2 See Practice Guide Page 66

17 17 Adopt Flow Sheet Offering: Tool to track activity and monitor patient progress “DIABETES DAYS” STEP 3 See Practice Guide Page 69 Sample

18 18 If EMR: Establish visit protocols with EMR Stamps EMR allows for development of “stamps”, “favorite notes” or templates Applied to specific health issues Will guide care delivery by team Can be a short cut for documentation to ensure consistency See Practice Guide Page “DIABETES DAYS” STEP 4

19 19 Diabetes Days – Sample EMR Stamp Initial Visit

20 20 Diabetes Days – Sample EMR Stamps DDay f/u today. See my DM sheets or flow sheet F1. Bloodwork results and medications reviewed with pt. including compliance. «yes»«no» Target organ damage - see problem list +PxHx above (MI/stroke/nephropathy/neuropathy/eyes/hypoglycemia/med intolerance) BP: HR: Wt: Kgs WH: last K030 - Oct 11, 2010 last Q040 - never done Foot check pt checks feet B. I. D.« yes»« no» Hypoglycemia no, Lifestyle ?smoking, exercise etc discussed Mood "Bothered in the past month by feeling down, depressed or hopeless" «n/a» «yes» «no» "Bothered in the past month by little interest or pleasure in doing things" «n/a» «yes» «no» Discussed DM pathophysiology, progression of DM, DM complicaitons, basic lifestyle management of blood sugars as appropriate Target BGs ac and pc meals discussed - Target (for most) N Range (if possible) Before Meals Hrs. After A1C ≤7 <6 Provided with - «Just the Basics,» «DM Hamilton,» «What is DM?,» «Managing DM,», «Highs and lows of blood sugars,» «Stand Up to Diabetes» Pt demonstrated a «good»«poor» understanding of discussion with appropriate comments and questions. Expect pt will make some changes. Issues identified: Not at target - «WT » «BP » «'lytes » «LFT's » «CK» «creat/eGFR » «HDL »«LDL » «ualb/creat » «FBG »«A1C » Pt may benefit from : F/u booked for: 3-4/12 with req. given to pt. for lab work and for them to make appt. Benefits and side effects of medications prescribed by me are discussed in detail with the patient. RBD of above Patient did 75 fm GTT, FBS, A1C, and micro albumin/creatinine ratio. Result is (DMI) (IFG) (IGT) Discussed with patient and offered, Appointment with hospital pre-diabetic, Appointment with our dietician, Appointment with our DM Nurse Educator, DVD, and Government Stand up to Diabetes number to call. Pt told to repeat bloodwork in 1 year. Following appointments made. IFG EGT Visit Ongoing Management Visit

21 21 Team Roles and Accountabilities Review patient needs based on patient types Establish team roles Activate plan to address any learning needs identified See Practice Guide Page “DIABETES DAYS” STEP 5

22 22 Diabetes Days: Schedule & Workflow Establish a coordinated schedule with the DHC team Involve all DHC Team members Establish workflow and room assignments Best Practice – do not book any other long appointments of physicals during this time Diabetes related visits only. Other issues to rebooked (within reason) See Practice Guide Page “DIABETES DAYS” STEP 6

23 23 Sample Joint Schedule (MD, RNx2, DNE) Annual Physical Advanced Access Diabetes Days (DM) Report Time/Calls Diabetes Days Diabetic Annual Visit Monday DIABETES DAYSTuesdayWednesdayThursday DIABETES DAYSFriday Timerm 1rm 2rm 3rm 4rm 56rm 1rm 2rm 3rm 4rm 56rm 1rm 2rm 3rm 4rm 56rm 1rm 2rm 3rm 4rm 56rm 1rm 2rm 3rm 4rm 5 8:00RN1/MD DNERN2/MD **RN1/MDRN1DNERN2/MDRN2**RN1/MDRN1DNERN2/MDRN2**RN1/MDRN1DNERN2/MD **RN1/MDRN1DNERN2/MD ** 8:15Annual report time Annual report time **Annual report time Annual report time **Annual report time Annual report time **Annual report time DMAnnual report time **Annual report time Annual report time 8:30Physical calls Physical calls **Physicial calls Physical calls **Physical calls Physical calls **Physical calls annualPhysical calls **Physical calls Physical calls 8:45 ** 9:00diabetic reg appt**reg appt **reg appt **DM reg appt**reg appt 9:15 ** annual ** 9:30diabetic ** DM ** 9:45 ** DM ** 10:00dibetic ** DM annualDM ** 10:15 ** 10:30 report time ** report time ** report time ** report time ** report time 10:45 Adv Acc ** Adv Acc ** Adv Acc ** Adv Acc DM Adv Acc ** Adv Acc 11:00 ** annual ** 11:15reg appt **reg appt **reg appt **reg appt **reg appt 11:30 ** DM ** 11:45 Adv Acc ** Adv Acc ** Adv Acc ** Adv Acc report time Adv Acc ** Adv Acc 12:00 lunch ** lunch ** lunch ** lunch ** lunch 12:15** 12:30** 12:45** 1:00DMreg apptDMreg appt**reg appt **reg appt **DMreg apptDM reg appt**reg appt 1:15 ** annual ** 1:30DM ** DM ** 1:45 ** DM ** 2:00DM report time DM ** report time ** report time ** report time annualDM ** report time 2:15 ** 2:30 Adv Acc report time ** Adv Acc report time ** Adv Acc report time **DMreg apptDM Adv Acc ** Adv Acc report time 2:45 ** annual ** 3:00reg appt **reg appt **reg appt **DM reg appt **reg appt 3:15 ** 3:30 ** DM ** 3:45 ** annual ** 4:00 Adv Acc ** Adv Acc ** Adv Acc ** Adv Acc ** Adv Acc 4:15 ** report time ** 4:30 report time ** report time ** report time ** report time calls report time ** report time 4:45 ** 5:00 after hours advanced access ** after hours advanced access ** after hours advanced access ** after hours advanced access ** after hours advanced access 5:15** 5:30** 5:45** 6:00 **

24 24 RN/DNE RN RN/DNE Reg Sample Joint Schedule (MD, RNx2, DNE)

25 25 Sample Clinic Work Flow: Diabetes Days Patient Type: Ongoing DM Management Exam Room 1 –DM Patient A: 15 mins RN: Examinations Results of investigations Discuss Patient Targets/Importance Develop or discuss goals to reach Targets Review and discuss patient self management Review current treatment and medications Update records Physician: Review Results and Plan with Patient and RN Answer Patient questions Completes any additional assessment or treatment changes required Exam Room 2– DM Patient B: 15 mins RN: Examinations Results of investigations Discuss Patient Targets/Importance Develop Goals to reach Targets Review and Discuss Patient Self Management Review Treatment and Medications Update records Physician: Review Results and Plan with Patient and AHCP Answer Patient questions Completes any additional assessment or treatment changes required Exam Room 3 – DM Patient C: 30 – 60 mins Dietician/Diabetes Nurse Educator First appointment for newly diagnosed Patient or yearly for ongoing patient management Physician: Review Results and Plan with Patient and Dietician/Diabetes Nurse Educator Answer Patient questions Completes any additional assessment required Exam Room 4 –Short Visit (if required) RN : Examinations as required Physician: Short Visit for acute issues only – no long appointments or physicals MD moves between rooms See Practice Guide Page 60-61

26 26 Patient Communication Critical for patients to understand they are integral part of the Diabetes Care Team Regular preventative visits essential Goals will be mutually set, progress tracked Communicate role of all staff in DHC and value of each team member contribution Role of Patient: active participation, goal setting, labs completed prior to visits, meds each visit See Practice Guide Page 62 “DIABETES DAYS” STEP 7

27 27 Patient Communication: The Basics Patient centered team based care strategy to improve patient health outcomes Healthcare team: Patient and Family, Physician, RN, DNE, Dietitian Importance of regular preventative care and patient self management Diabetes only issues addressed Labs completed prior to appointment Patient to bring medications to Diabetes Day visits Setting goals, tracking outcomes against targets at each visit

28 28 Implement Diabetes Days Initially may take 3 – 6 months to establish Start with two appointments per “day”, increase as more patients are enrolled Initiate process for staff and patient feedback See Practice Guide Page “DIABETES DAYS” STEP 8

29 29 Monitor Effectiveness Determine criteria to monitor diabetes days effectiveness –Patient health outcomes –Process outcomes –Patient satisfaction –Provider satisfaction See Practice Guide Page “DIABETES DAYS” STEP 9

30 30 Quality Improvement: PDSA Establish PDSA objectives and timelines Establish outcome targets, measures and timelines See Practice Guide Page 90 “DIABETES DAYS” STEP 10 PPLAN DDO SSTUDY AACT

31 31 Clinic Diabetes Management Dashboard

32 32 Pathways Dashboard: Narrative Report Key Changes –Describe changes made in the way you care for patients with diabetes PDSAs –List two or three critical PDSAs that helped you achieve the changes above Impact on Outcomes –Describe how you believe these changes impacted particular outcomes you are monitoring What next? –Describe what you will be doing regarding future improvements.

33 33 Clinic Team Regroup Q and A

34 34 Wrap up Parking lot Measure Effectiveness – Complete CHE Evaluation Form and hand in prior to leaving


Download ppt "1 “Diabetes Days” A Practice Efficiency Strategy Improving Diabetes Mellitus Patient Care Delivery & Outcomes."

Similar presentations


Ads by Google