AIM: 
By April 2016, we aim to improve Complete Diabetic Care of Thursday JHAP Clinic\u27s patients with diabetes by 50%.
* These authors contributed equallyhttps://jdc.jefferson.edu/patientsafetyposters/1007/thumbnail.jp

Caruson, MD, John

Chen, MD, Loren

Lee, MD, Albert

Liss*, MD, Alison

Minasyan*, MD, Hasmik

Shah*, MD, Mansi

English

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsHouse Staff Quality Improvement and PatientSafety Posters GME Quality and Safety6-10-2016Got Diabetes? With Us, You'll Have CompleteDiabetic CareMansi Shah*, MDJefferson Hospital Ambulatory Practice, Thomas Jefferson University Hospital, mansi.shah@jefferson.eduHasmik Minasyan*, MDJefferson Hospital Ambulatory Practice, Thomas Jefferson University Hospital, Hasmik.minasyan@jefferson.eduAlison Liss*, MDJefferson Hospital Ambulatory Practice, Thomas Jefferson University Hospital, alison.liss@jefferson.eduJohn Caruson, MDJefferson Hospital Ambulatory Practice, Thomas Jefferson University Hospital, john.caruso@jefferson.eduLoren Chen, MDJefferson Hospital Ambulatory Practice, Thomas Jefferson University Hospital, loren.chen@jefferson.eduSee next page for additional authorsFollow this and additional works at: http://jdc.jefferson.edu/patientsafetypostersPart of the Medicine and Health Sciences CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inHouse Staff Quality Improvement and Patient Safety Posters by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationShah*, MD, Mansi; Minasyan*, MD, Hasmik; Liss*, MD, Alison; Caruson, MD, John; Chen, MD, Loren; and Lee, MD, Albert, "GotDiabetes? With Us, You'll Have Complete Diabetic Care" (2016). House Staff Quality Improvement and Patient Safety Posters. Poster 11.http://jdc.jefferson.edu/patientsafetyposters/11AuthorsMansi Shah*, MD; Hasmik Minasyan*, MD; Alison Liss*, MD; John Caruson, MD; Loren Chen, MD; andAlbert Lee, MDThis poster is available at Jefferson Digital Commons: http://jdc.jefferson.edu/patientsafetyposters/111.80% 3.30% 8.20% 8.20% 14.10% 14.30% 25.70% October  November December January February March April 2015 2016 % of Patients Monthly Review of PCP Quality Report: Completed DM Care Got Diabetes? With Us, You’ll Have Complete Diabetic Care  Jefferson Hospital Ambulatory Practice (JHAP) Thomas Jefferson University Hospital  Mansi Shah* MD, Hasmik Minasyan*, MD, Alison Liss*, MD John Caruso, MD, Loren Chen, MD, Albert Lee, MD *These authors contributed equally AIM By April 2016, we aim to improve Complete Diabetic Care* of Thursday JHAP Clinic patients with diabetes by 50%. *annual A1c, lipid panel or already on a statin, urine microalbumin or on ACE-I or ARB, ophthalmology referral, podiatry care BACKGROUND RESULTS DISCUSSION PROCESS MAP Screening, diagnostic and therapeutic actions are known to favorably affect health outcomes of patients with diabetes. Only 3.3% of Thursday JHAP patients with diabetes had complete diabetic care as of Nov 2015 Ø  Only 75% of patients had annual A1c, significantly below the average for the rest of the other JHAP clinics Ø  Virtually no documentation of ophthalmology or podiatry referral results JHAP Baseline Patient Statistics:  •  Thursday  Clinic successfully improved rates of Complete Diabetic Care •  Discovered flaw in measuring process in PCP Quality Reports despite completion of diabetic care. –  Led to improved measuring process for entire TJU institution and re-appropriation of resources LIMITATIONS •  Residents with extended time out of the   ambulatory clinic •  Lack of consistent follow up visits •  Patients lost to follow up due to insurance or migration •  Lack of monetary support, inefficient EMR system FUTURE PLANS •  Plan to extend to other JHAP Clinics via resident training sessions •  JHAP is anticipating the addition of a case manager, who will assist us in reaching our final goal and sustain this intervention •  Provide visual triggers in patient rooms •  Pharmacist referral for diabetic teaching, BP control, and A1C management.    September 2015 •  EMR Initiative •  Active DM Patient List •  EMR-Based DM Flowsheet utilization October 2015 •   Physician Education: Guidelines for DM Care and DM Flowsheet •  Structural Improvements •  Monofilaments made available •  Encouraged same visit lab draws November 2015 •  Diabetes Visit Checklist •  Review of PCP Quality Report December 2015 •  Completed EMR Updates •  EMR Dashboard Reminders •  Patient Appointment & Referral Reminders by Staff and Physicians January 2016 •  Individualized PCP Chart Audits •  Patient Appointment Reminders •  Physician initiated phone calls February 2016 •  Review of PCP Quality Report March 2016 •  Consolidated Geographic Referral List •  Insurance Specific Specialist Recommendations •  Periodic Statistics Review April  2016 •  Results Review •  Review of PCP Quality Report  INTERVENTION JHAP Thursday  increased from 3.3% to 25.7% Total JHAP’s Complete Diabetes Care increased from 4.8% to 8.2% FISHBONE: To Identify Potential Interventions 0.0 5.0 10.0 15.0 20.0 25.0 11/6/15 1/4/16 4/30/16 Percentage of Patients with Complete Diabetic Care Percentage of Diabetic Patients with Complete Diabetic Care by JHAP Day Monday Tuesday Wednesday Thursday Friday Red text = addressed or intervened Office visit for patient with Diabetes DM addressed? Diabetic Care up to date? A1c in 6 months? Retinopathy screening in last year? Foot exam in last year? Lipids in last year or on statin? Microalbumin in last yaer or on ACE-I? Update EMR ! ! !YES!NO!YES!YES!YES!YES!Reschedule follow-up visit Continue current plan Draw A1C at visit Give ophthalmology referral per patient’s insurance/location Perform Monofilament Testing or give Podiatry referral Order lipids or start statin Order urine microalbumin or start ACE-I NO!YES!NO!NO!NO!NO!NO!Total JHAP: Patients with DM/Total Patients 346/1772 (19.5%)  Thursday JHAP: Patients with DM/Total Patients 74/378 (19.6 %) 

Got Diabetes? With Us, You\u27ll Have Complete Diabetic Care

AIM: 
By April 2016, we aim to improve Complete Diabetic Care of Thursday JHAP Clinic\u27s patients with diabetes by 50%.
* These authors contributed equallyhttp://jdc.jefferson.edu/patientsafetyposters/1007/thumbnail.jp

Name not available

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1007&amp;context=patientsafetyposters

Got Diabetes? With Us, You\u27ll Have Complete Diabetic Care

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