1. Focus on Quality Webinar July 2018 Indiana Quality Improvement Network
Maureen Moynihan, PharmD
Clinical Pharmacist
Phone: ext.: 3777

2. Indiana State Department of Health Primary Care Learning Collaborative
Provider Team:
Nurse Practitioner
Registered Nurse
Clinical Pharmacist
Certified Medical Assistant
One focus: ↓ # of uncontrolled patients with diabetes on provider panel

3. DIABETES A1C CONTROL v
DIABETES A1C POOR CONTROL: *a lower percentage is better*
Baseline: 37%
Goal: 20%
Current: 18.5%
(as of 06/12/18)

4. v SUCCESSFUL PDSA Diabetes A1C Deficiency Call List:
Plan: A deficient patient call list was generated. The provider team called those patients and scheduled appointments for them to come and address their gaps in care; they also flagged patients who were already scheduled for appointments, to discuss missing measures with them at the time of their visit.
Do: Ran the test on a month-to-month basis.
Diabetes: Aug 2017: 33.5%, September 2017: 28.7%
Study: Provider team decided to continue with the call list as it notifies healthcare team and patient to the screening gap. Also the use of a pharmacy student to scrub the list and make the phone calls in order to maximize provider time.
Act: Scrub the list quarterly for best use of time.

5. USEFUL RESOURCES
Clinical Pharmacist Insulin Titration Follow-up Call List
Insulin-treated patients with uncontrolled diabetes are followed up within 1-2 weeks period via phone to adjust insulin doses based on a collaborative practice agreement.

6. USEFUL RESOURCES Diabetes Self-Management Education
All Provider Team Members Involved
Set Class Curriculum:
Meals
Monitoring
Movement
Medications
Long-term Complications
Standards of Care
Support System

7. USEFUL RESOURCES
Opportunity to learn from providers and other patients
Less time constraints than provider appointments to give comprehensive education on diabetes self-management
Allows provider team to assess patient confidence in self-management skills
Gives provider team the opportunity to identify and remedy deficiencies in diabetes patient education
Gives a setting for patient to set self-management goals with check-ins at future classes

8. TAKE HOME TIPS Follow-up is KEY! Teamwork is KEY!
Patient Education is KEY!