1. How Could UW Health Provide the Best Diabetes Care in Wisconsin? Sue Pelatzke Michael Barbouche Lawrence Fleming, M.D. June 15, 2005

2. Presentation Objectives 1.Introduce the Wisconsin Collaborative for Healthcare Quality (WCHQ). 2.Review UW Health’s performance in diabetes care. 3.Discuss how, within UW Health, we could improve diabetes care.

3. About WCHQ? The Wisconsin Collaborative for Healthcare Quality was founded in 2002 Participation of health care systems, physician groups, hospitals, employer/consumer groups is voluntary Collaboration on improving healthcare in Wisconsin by developing a set of outcome measures of quality Public reporting of performance of participating healthcare organizations

4. WCHQ Growth 2002 – 6 health systems in non-competing markets 2004 – 12 health systems statewide –11 Hospitals –12 Physician Groups –5 Employers/Consumer Groups –Independent Auditor – MetaStar

5. Present WCHQ Member Organizations Advanced Healthcare, S.C. Affinity Medical Group Aspirus, Wausau Hospital Belin Health Columbia St. Mary’s Dean Health System Franciscan Skemp Healthcare Froedert and Community Health Gundersen Lutheran Luther Midelfort Marshfield Clinic Medical Associates Health Center Medical College of Wisconsin Meriter Hospital and Physicians Plus Insurance

6. Present WCHQ Member Organizations Prevea Health Services Sacred Heart Hospital Saint Joseph’s Hospital St. Mary’s Hospital Medical Center ThedaCare UW Hospital and Clinics UW Medical Foundation

7. WCHQ Member Organizations Agree To: Share comparative quality performance data among members for the purpose of improving performance Independent third-party audit and data validation Publicly report comparative quality performance data

8. WCHQ Measures The “Six IOM Aims” for improving the quality of healthcare: –Safety –Timeliness –Effectiveness –Efficiency –Equity –Patient-Centeredness

9. WCHQ Measures The Clinical Topics –Access –Critical Care –Diabetes –Health Information Technology –Heart Care –Patient Satisfaction –Pneumonia –Surgery –Women’s Health

10. Value of Public Reporting There is little evidence that public reporting will change consumer choice of health care providers, or will improve quality HOWEVER, UWMF’s and UWHC’s participation has provided the stimulus to measure quality across the UW Health system and will direct and quantify subsequent improvement

11. The Process, with Diabetes Care as an Example 1.Defining the measures 2.Finding the data

12. The Diabetes Care Measures 1.Blood sugar (A1c) testing within the last 12 months 2.LDL cholesterol testing within the last 12 months 3.Kidney function monitored within the last 12 months 4.Blood sugar (A1c) control 5.LDL cholesterol control

13. Collecting the Data for the Five Diabetes Measures Numerators Obtained from administrative data (billing) Or Specific Lab/Clinical Values __________________________ Denominator Identifies current/active patients with diabetes and is obtained from administrative data

14. Building the Denominator

15. Finding UW Health Lab Data – Eliminate Black Holes and Dead Ends

16. How are Data Collected, Reported? 2005 -April, 2005, the first public reporting of the performance data for participating entities. -UW submitted one number for each measure for all of UW Health. So, the one number reflects performance across all UW Health Clinics and for 5,298 patients with diabetes (5,298 is the denominator). 2006 and beyond -Public reporting may be more focused to the clinic level or even individual physician level.

17. UW Health’s Performance in Screening Measures for Patients with Diabetes for 7/1/03-6/30/04 A1c screening (4,944 / 5,298) = 93.3% LDL screening (3,742 / 5,298) = 70.6% Nephropathy screening (3,960 / 5,298) = 74.5%

18. UW Health Diabetes Screening Rates A1c LDL Nephropathy

19. Glycemic Control Measure  “Optimal”- A1c < 7%  “Near optimal”- A1c 7% to 9%  “Poor control”- A1c > 9%  “Not tested”

20. LDL Control Measure for Patients with Diabetes  “Optimal”- LDL < 100 mg/dL  “Near optimal”- LDL 100-130 mg/dL  “Poor control”- LDL > 130 mg/dL  “Not tested”

21. UW Health Diabetes Control

22. Diabetes Screening Rates UW Health Internal Medicine Clinics

24. Diabetes A1c Control UW Health Internal Medicine Clinics

25. Diabetes LDL Control UW Health Internal Medicine Clinics

26. How Might We Improve Glycemic Control in Our Patients with Diabetes?  Improvement will require the talents and energy of an entire clinic staff.  Improvement will come only if it is a priority of the clinic staff; the physicians need to be committed to improvement in order for the clinic to be committed.  Each clinic staff should decide how they will improve the care of patients with diabetes.

27. How Might We Improve Glycemic Control in Our Patients with Diabetes? Some Tools.  Data: Quarterly reports to each clinic that list patient name, PCP, last visit, most recent A1c.  A process that allows clinic staff to complete a lab request for overdue A1c, LDL profile, or urine microalbumin.  Access to the services of Certified Diabetes Educators. ?Group sessions for patients.  Improve self help web-based tools for patients with diabetes.  Point of care A1c testing.

28. How Might We Improve Glycemic Control in Our Patients with Diabetes?  For those patients who are currently in the “near optimal” control group, moving to “optimal” might mean: 1.Physician, NP, or PA discussing at each visit the benefits of optimal glycemic control. 2.Refresher course on dietary changes for improved control. 3.Regular reminder at visits of the importance of exercise in glycemic control. 4.Medication changes.

29. How Might We Improve Glycemic Control in Our Patients with Diabetes?  For those patients who are currently in the “poor control” group, moving to “near optimal,” or “optimal,” might mean: 1.Physician, NP, or PA discussing at each visit the benefits of optimal glycemic control. 2.Refresher course on dietary changes for improved control. 3.Regular reminder at visits of the importance of exercise in glycemic control. 4.Medication changes. 5.Referral to a Certified Diabetes Educator

30. How Might We Improve Glycemic Control in Our Patients with Diabetes?  For those patients who are currently in the “not tested” group, the first step is contacting the patient and arranging the testing and an office visit.