Diabetes Best Practices Symposium Sponsored by AMGA and Merck

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Diabetes Best Practices SymposiumSponsored by
AMGA and Merck Co., Inc..October 21-22,
2009Detroit, MI

• Holzer Clinic, Inc.
• A Collaborative Effort in Diabetes Care

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Medical Group Profile

• Established in 1949 by Dr. Charles Holzer
• Physician Group Practice with over 130 Board
  Certified Physicians representing 36 specialties
  
• Nine locations throughout southeastern Ohio and
  western West Virginia
• Provide Service to 14 counties with an average
  of 500,000 outpatient visits per year
• Over 1,100 employees
• Payer mix is 54 Medicare/Medicaid

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Team Composition

• Allison Connors, J.D.
• Quality Coordinator
• Angel Beck Kimble, Pharm. D.
• Ambulatory Care Pharmacist
• Cheryl Browning
• Quality Auditor
• Jeremy Peck
• Computer Analyst

• Lois Bosley, M.D.
• Physician Champion
• Renuka Kandula, M.D.
• Physician Champion
• Glenn Davis, M.D.
• Physician Champion
• Rodney Stout, M.D.
• Endocrinologist
• Doug Adkins, RN, BSN
• Team Clinical Expert

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Diabetes Goals Objectives

• To provide comprehensive diabetes care to all of
  our patients in order to improve patient outcomes
  using a multidisciplinary team-based approach,
  evidence-based medicine, health information
  technology and patient self-management tools.

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Diabetes Intervention Population Baseline

• Population of Focus
• Patients aged 18 years and older with a diagnosis
  of diabetes mellitus.
• Electronic Medical Record
• All Clinic sites have access to Allscripts
  (Touchworks) EMR allowing for immediate access to
  individual patient information to all providers

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• Improvement Interventions
• EMR Alerts

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• Retrospective Data Extraction/Collection
• Query data elements using our practice management
  system and clinical information system.
• Generate quarterly reports for each location,
  department and individual physician.
• Automated Messaging System (Phytel)
• Appointment reminders
• Generates new encounters by notifying patients
  when treatment is required based on chronic care
  protocol

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Motivating Physicians

• Incorporation of clinical performance data in the
  Peer Review process
• Individual physician data is shared among the
  physicians, nursing staff, and administration
• Pay-for-Performance
• Participation in the CMS Physician Quality
  Reporting Initiative
• Claims-based reporting mechanism for 4 diabetes
  measures

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Establishing a relationship

• Bringing Clinical Pharmacy to HC
• University of Charleston School of Pharmacy
  Affiliation Agreement

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Collaborative goals
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Ambulatory care Pharmacist

• Disease State Education
• Blood Glucose Meters
• Self Management of Blood Glucose
• Patient Drug Assistant Programs
• Diabetes Team
• Diet, Exercise, and Lifestyle Recommendations

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Mistaken Perception

• Patients feel they have done something wrong
  when additional therapy is added on.
• Key time to ensure that patient understands that
  Diabetes is a progressive disease
• They feel shamed and often feel more treatment
  is their punishment for their failure
• It is important to discuss and let them know that
  this rise in the glucose or A1C could have
  progressed even if they were 100 perfect with
  treatment and adherence
• Explain the rate of beta cell dysfunction
• Point out risks for long term complications with
  uncontrolled glucose to help motivate the patient
  to achieve the target glucose levels

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Improving Adherence

• Disease State Education
• Understanding Diabetes and its Treatment Options
• Reviewing Medications
• Discuss most common side effects and ways to
  minimize them
• Cost
• Is their a cheaper alternative with the same
  documented efficacy

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Patient Safety Clinical Pharmacy
Collaborative Goals

• Improve Health Outcomes by focusing on
  implementing effective patient safety principles
  and clinical pharmacy services
• Improve Patient Safety
• Fewer errors, fewer injuries, less harm
• Increase High Quality, Cost-Effective Pharmacy
  Services
• Optimal utilization of clinical pharmacists and
  clinical pharmacy services across multiple
  providers of care
• Maximizing and enhancing medication use
  management
• http//www.hrsa.gov/patientsafety/

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Measures

• Key Quality Measurements
• National recommendations from the ADA, CMS and
  ICSI

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Challenges Obstacles

• Physician Autonomy
• Lack of consensus in determining department
  practice standards
• Lack of confidence in EMR gathered information
• Variations in physician documentation
• Data inaccuracies

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Outcomes Successes
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Future Steps

• Utilize the intranet and internet for access and
  feedback of provider specific information
  (transparency)
• Expand Diabetes Education
• Broaden the population of focus to include
  pre-diabetes patients
• Adopt point of care A1C testing

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Questions?
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Diabetes Best Practices SymposiumSponsored by
AMGA and Merck Co., Inc..October 21-22,
2009Detroit, MI

• Holzer Clinic, Inc.
• A Collaborative Effort in Diabetes Care