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Improving the quality of comprehensive diabetes care in primary care at Loyola University Health System. Coordinated by Michael Koller, M.D. Opportunity Statement and Desired Outcome. Diabetes Mellitus (DM) can cause complications which result in significant morbidity and early mortality.

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slide1

Improving the quality of comprehensive diabetes care in primary care at Loyola University Health System

Coordinated by Michael Koller, M.D.

opportunity statement and desired outcome
Opportunity Statement and Desired Outcome

Diabetes Mellitus (DM) can cause complications which result in significant morbidity and early mortality.

GOAL = Promote adherence to a protocol based on recommendations from the American Diabetes Association to reduce the risk of developing these complications in adults age 18-75 with diabetes.

elements of the dm protocol
Elements of the DM protocol
  • Blood pressure screening and treatment if >130/80
  • Daily aspirin use, if not contraindicated
  • Annual dilated eye examination
  • Annual monofilament foot examination
  • Annual (or more frequently as indicated) laboratory measurement of:
    • Hemoglobin A1C (goal <7)
    • Lipid Profile/LDL (LDL goal < 100)
    • Urine for microalbumin or 24 hour urine protein
  • Vaccinations

- Influenza

- Pneumovax

most likely causes
Most Likely Causes

Patient non-compliance to protocol due to:

  • Lack of knowledge about their disease
  • Lack of money for medications/medical care
  • Lack of success in making necessary lifestyle changes to comply with protocol

Clinical staff non-compliance to protocol due to:

  • Lack of knowledge concerning patient educational resources available through the Diabetes Center
  • Lack of frequent office visits to instruct and encourage patient to comply with protocol
  • Insufficient awareness of personal practice patterns
  • Difficult for clinicians to recall all 12 protocol elements at every office visit
solutions implemented
Solutions Implemented
  • Promoted outpatient diabetes management order set
  • Continued to partner with LUHS Diabetes Care Center
  • Audited regularly (following National Quality Forum’s National Voluntary Consensus Standards for Adult Diabetes Care
  • Provided personalized feedback to physicians on their practice patterns by the medical director of QI for primary care
  • Included physician’s performance in yearly faculty review and re-credentialing process
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6/03 UHC

PC best decile for A1C = 100%

PC best decile for LDL = 91%

PC best decile for urine = 65%%

conclusions next steps
The PC network provides excellent DM care, above 90%tile on 6/7 HEDIS 2004 DM measures

Protocol compliance continues to improve

More diabetics are achieving goals

LUHS is well prepared for imminent public reporting of ambulatory DM measures

Continue:

Periodic auditing of labs and charts

Providing individual feedback to physicians

Including results of audits in annual faculty review and re-credentialing

Utilize EPIC reminders to increase compliance

Conclusions Next Steps