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Moving Pickens County Primary Care towards Patient-Centered Medical - - PowerPoint PPT Presentation
Moving Pickens County Primary Care towards Patient-Centered Medical - - PowerPoint PPT Presentation
Moving Pickens County Primary Care towards Patient-Centered Medical Home Qualifications through a Diabetes Self-Management Education Program Elizabeth Junkin, MS3 Outline Results/ Background Objectives Methods Impact Outline Results/
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Outline
Background Objectives Methods Results/ Impact
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Pickens County, AL
- Population: 19,349
- 7 primary care physicians
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Pickens County, AL
Pickens County Primary Care
- Dr. Julia Boothe
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Pickens County, AL
- 15.1% of the population
>20 years old has been told by a physician they have diabetes
- 12.12% in the state of Alabama
- 9.11% in the United States
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Why a Diabetes Self-Management Education (DSME) Program?
- Patients are more likely to engage in
preventative care services and are less likely to participate in risky health behavior.
- Goal for Healthy People 2020:
- Increase the amount of diabetic patients that
receive diabetes education training to 62.5%
- In 2008, only 56.8% of diabetic patients reported
they participated in a diabetes education program
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Which Patient-Centered Medical Home (PCMH) qualification will this fulfill?
- The Quality and Safety standard set by the
Joint Principles of the Patient-Centered Medical Home
- Involves assuring the patient participates in the
decision-making process
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Why must the DSME be recognized by the American Diabetes Association (ADA)?
- Recognition is mandatory in order to receive
reimbursement from Medicaid and Medicare.
- Standards based on National Standards for
Diabetes Self-Management Education and Support
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National Standards for Diabetes Self-Management Education and Support
1
Internal Structure
2
External Input
3
Access
4
Program coordination
5
Instructional staff
6
Curriculum
7
Individual- ization
8
Ongoing support
9
Patient progress
10
Quality improvement
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DSME Curriculum
- 1. Diabetes disease process
- 2. Nutritional management
- 3. Physical activity
- 4. Medications
- 5. Monitoring blood sugar
- 6. Acute complications
- 7. Chronic complications
- 8. Psychosocial issues
- 9. Health and behavior change
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Outline
Background Objectives Methods Results/ Impact
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Outline
Background Objectives Methods Results/ Impact
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Objectives
1.
What are the characteristics, health status, and educational needs of the diabetic patients at Pickens County Primary Care, and are they interested and/or willing to participate in a DSME Program?
2.
Is the staff of Pickens County Primary Care interested and/or willing to be involved in the creation and implementation of a DSME Program?
3.
Does Pickens County Primary Care have the resources and staff to meet the requirements for their DSME Program to receive recognition from the American Diabetes Association Education Recognition Program?
4.
What curriculum and structure should the DSME Program for Pickens County Primary Care follow to best meet their patients’ educational and support needs?
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Outline
Background Objectives Methods Results/ Impact
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Outline
Background Objectives Methods Results/ Impact
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Methods
DSME Implementation Plan EHR Review Patient Survey Clinic Staff Survey
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EHR Review
- Assess the total number of diabetic patients
- Assess complications, controlled vs.
uncontrolled, and number of diabetes-related visits through ICD-9 codes
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All codes for Type II Diabetes
ICD-9 Code Complication Controlled/ Uncontrolled
250.00 None C 250.02 UC 250.10 Ketoacidosis C 250.12 UC 250.20 Hyperosmolarity C 250.22 UC 250.30 Other Coma C 250.32 UC 250.40 Renal C 250.42 UC 250.50 Ophthalmic C 250.52 UC 250.60 Neuro C 250.62 UC 250.70 Peripheral Circulatory Disorder C 250.72 UC 250.80 Other C 250.82 UC 250.90 Unspecified C 250.92 UC
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Patient Survey
- Based on Diabetic Care Profile by the
Michigan Diabetes Research and Training Center Topics Include:
Demographics Health status Education/advice received Understanding of diabetes care Social support Logistics of classes Transportation availability Technology access General interest
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Clinic Staff Survey
- Assess the resources and willingness of the
staff to help with the development and implementation of a DSME program
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Methods
DSME Implementation Plan EHR Review Patient Survey Clinic Staff Survey
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Outline
Background Objectives Methods Results/ Impact
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Outline
Background Objectives Methods Results/ Impact
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Results of EHR Review
(Data from July 2014 to Dec 2014)
- Estimated # of patients: 5200
- Total number of diabetic patients seen: 342
- Gender
- 59% females
- 41% males
- Age
- Average: 62
- Min: 15
- Max: 96
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Results of EHR Review
10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100 F 2 1 6 17 42 67 44 21 2 M 9 26 35 36 26 8
10 20 30 40 50 60 70 80
Number of patients Age Ranges
Age and Gender Distributions
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Results of EHR Review
- Total number of visits: 858
- Average of 2.5 visits per patient
- Max # of visits: 10
# Patients with 250.00 (C) and 250.02 (UC) 202 (59%) 38 (11%) 102 (30%) Only 250.00 Only 250.02 Both
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Results of EHR Review
592, 71% 246, 29% Controlled vs. Uncontrolled Visits
250.00 (controlled) 250.02 (uncontrolled)
1 1 1 15 1 1
Visits with Complications
250.30 (coma, C) 250.50 (eye, C) 250.52 (eye, UC) 250.60 (neuro, C) 250.62 (neuro, UC) 250.92 (unspecified, UC)
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Results
To be continued…
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Impact
- Needs assessment of the diabetic patient
population at Pickens County Primary Care
- Selection of the best curriculum for the clinic
- Preliminary plan of implementation for a
DSME Program
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Acknowledgements
- Dr. Lea G. Yerby
- Partially supported by the Alabama Family
Practice Rural Health Board
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References
1.
Map of Alabama highlighting Pickens County, Courtesy of Wikimedia Commons, accessed on 4/13/15
2.
US Department of Health & Human Services, Health Resources and Services Administration, Area Health Resource File. Courtesy: Community Commons, January 24, 2015, date retrieved.
3.
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Courtesy: Community Commons, April 3, 2015, date retrieved.
4.
Strine TW , Okoro CA, Chapman DP, Beckles GL, Balluz L, Mokdad AH. The impact of formal diabetes education on the preventive health practices and behaviors of persons with type 2 diabetes. Prev Med. 2005 Jul;41(1):79-84. Epub 2004 Nov 19. PubMed PMID: 15916996.
5.
Healthy People 2020. (2015). Retrieved from https://www.healthypeople.gov/2020/topics-
- bjectives/topic/diabetes/objectives
6.
American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA). Joint principles
- f the patient-centered medical home. http://www.aafp.org/dam/AAFP/documents/
practice_management/pcmh/initiatives/PCMHJoint.pdf . Accessed January 24, 2015.
7.
Haas L, Maryniuk M, Beck J, Cox CE, Duker P, Edwards L, Fisher EB, Hanson L, Kent D, Kolb L, et al. National standards for diabetes self-management education and support. Diabetes Care. 2014 Jan;37 Suppl 1:S144-53. doi: 10.2337/dc14-S144. PubMed PMID: 24357210; PubMed Central PMCID: PMC4181074.
8.
Fitzgerald JT, Davis WK, Connell CM, Hess GE, Funnell MM, and Hiss RG, "Development and Validation of the Diabetes Care Profile," Evaluation and the Health Professions, 1996; 19(2): 209-231.
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