1. Problem Declining referrals from inpatient to outpatient
Inpatient education service discontinued
Hospital staff not familiar with Joslin services

2. Data Patients with Diabetes account for 30% of hospital admissions
85% of outpatient follow-ups referred by our Joslin endocrinologists
Endocrinology consults make up only 20% of all consults (inpatient)

3. Solutions Educate PCPs, Hospitalists and Nursing
Diabetes Care Collaborative Team participation
Diabetes Nurse Champion on each inpatient unit
Simplify referral process
Develop education DVD (potential routing mechanism to Joslin outpatient)

4. Outcomes Pre Average referral about 2/month Post
Average referral ranging between 10 and 16/month

5. The Western Pennsylvania Hospital Forbes Regional Campus
 DIABETES EDUCATION PRESCRIPTION
NAME______________________________SSN________________________DOB____________
 PHONE (H)______________________(W)_____________________(C)____________________
 TYPE OF CONSULTATION:
Comprehensive Diabetes Education : FBS________ HbA1C______
Group______ or Individual________
Insulin Instruction Type________ Dose_________________
Medical Nutrition Therapy/Non Diabetes
Reimbursement Requirements: To meet Medicare and other insures’ regulations, please complete all sections
Diagnosis:
DIABETES: TYPE 1 ____ TYPE 2 ___ GESTATIONAL ___
Obesity/Weight Management ______ Hypertension ________
Lipid Disorder______ Pre Diabetes_______ Other __________
Referral to Endocrinologist (only if specifically ordered): Dr.Rajupet____ Dr. Sharma ____ Dr. Tal _____
Current Complications: Retinopathy___ Neuropathy___ Nephropathy___ Cardiac___
Medicare provides coverage for DSMT services when a provider providers a referral certifying that DSMT services are needed
I certify that DSMT services are needed under a comprehensive plan for this patient’s diabetes care.
Physician Signature_________________________________________________Date______________________
Print Physician Name__________________________________________________________________________
The Joslin Diabetes Education program has met the American Diabetes Association National Standards for Diabetes Education Programs