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Enhancing Diabetes Care: Next Steps for Improvement in Patient Management

This guide outlines the next steps for healthcare providers working with diabetes patients to enhance care and improve health outcomes. Key strategies include utilizing practice facilitators as resources, scheduling regular team meetings, collecting necessary data, and reaching out to overdue patients. Implementing critical changes in reporting forms and maintaining a proactive approach to patient management through follow-ups, risk assessments, and planned care at every visit is essential. Participation in webinars and learning sessions will support continuous improvement.

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Enhancing Diabetes Care: Next Steps for Improvement in Patient Management

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  1. Next Steps Robert A. Gabbay, MD, PhD Professor of Medicine, Penn State College of Medicine

  2. Until we meet again… • Use your practice facilitator as a resource. • Meet with and call Patty/Sharon: Pick a date today! • Reflect on and respond to their feedback • Continue (or start) holding weekly team meetings. • Develop a plan to collect any data you don’t have or correct any data you know is wrong. • Identify diabetes patients overdue for visits and reach out to them to schedule a visit and provide follow-up care.

  3. Until we meet again… • Continue implementing critical changes on monthly reporting form. • Population alert • Template/flow sheet • Standing orders • Huddles • Planned care at every visit • Patient report cards • Patient self-mgmt goals • Risk assessment at every visit • Follow-up care for high-risk

  4. Until we meet again… • Show significant and sustained improvement in at least 1 outcome measure and 3 process measures. • Keep on reporting PDSAs, data, status reports. • Participate in webinars: 12pm-1pm • Feb. 21 ▪ March 28 • April date tba • Tell us what you need!

  5. Monthly Report Due Dates • February 5 • March 5 • April 5 • May 6 • June 5

  6. Learning Session #4 South Central • May 9: 5-9pm at PSU College of Medicine, Hershey Northwest • May 16: 5-9pm at Cross Creek Resort, Titusville

  7. Practice Facilitators • Northwest Patricia J. Stubber, MBA Executive Director Northwest PA AHEC 8425 Peach Street Erie, PA 16509-4788 814-217-6029 (phone) 814-594-4740 (cell) 814-864-4077 (fax) pstubber@nwpaahec.org • South Central Sharon M. Adams RN, BA Executive Director Southcentral PA AHEC PO Box 509 Carrolltown, PA 15722 814-344-2222 (phone) 814-344-2221 (fax) sadams@scpa-ahec.org Web: www.paspread.com Email: paspread@hmc.psu.edu

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