Northeast Cluster Castaer General Hospital, Inc'

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Northeast ClusterCastañer General Hospital, Inc.

• Location Road 135, Km. 64.2, Lares, PR
• Size 9 providers full time
  
• 7 providers part time
• Programs offered at center 24 hour Emergency
  Care, Dental Services, Emergency Transport
  Service Family, Pediatritian, OB/Gyn and
  Internal Medicine Family Planning, In-Patient
  Care, Laboratory, X Rays, Sonography, Pharmacy
  Services, Respiratory Therapy Services, Social
  Services, Dietitian Service, and Surgery Service.
• Population served 1,200 patients diagnosed
  with diabetes condition
• Ethnic mix Hispanic or Latino 100

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Castañer General Hospital, Inc.Team Members
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AIM

• Castañer General Hospital will redesign their
  delivery system using
• the components of the Chronic Care Model to
  improve Diabetes
• management as evidenced by improvement in the
  following key
• measures
•         
• Key Measures
• Average HbA1c of 7.0 for DM Patients
• 90 DM patients with two (or more) HbA1c in last
  12 months (gt90 days apart)
• 70 DM patients with SM goal setting in last 12
  months
• 40 DM patients with BP lt130/80
• 70 DM patients with LDL lt100
• 80 patients on aspirin or antithrombotic agent
  age 40 or older

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Population of Focus

• The Castañer General Hospital population of focus
  will consist of the 150 patients from Dr. José
  Rivera and Dr. José Rodríguez panel of primary
  care patients.
• Dr. José Rodríguez and Dr. José Rivera chose the
  patients because they have the highest number of
  Diabetes Mellitus patients.

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Core Measures of Diabetes Mellitus

• Average HbA1c of 7.0 for DM patients
• 90 DM patients with two (or more) HbA1c in last
  12 months (gt90 days apart)
• 70 DM patients with SM goal setting in last 12
  months

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Key Diabetes Measures
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Senior Leadership Support

• How was leadership supported the team?
  Leadership has supported the team by working to
  participate and provide resources to encourage
  others to participate in the HDC.
• How has middle management been engaged to support
  the team? Middle management provide time,
  materials and necessary support to all team
  members.
• How did leadership engage and gain support from
  Board of Directors? The CEO provided and
  overview of the HDC to the Board of Directors and
  how important it is to participate in this type
  of opportunity. As we move toward more outcome
  based client care, this process will help provide
  the tools we need to succeed.

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Registry

• Registry used at our Health Center will be PECS.
• How we populated/entered patient data into
  registry by February 2005
• We identified diabetic patients by a register of
  every physician champion, special diabetic
  clinic, and we request to the private health
  insurance diabetic patient evaluated in the last
  six months.
• Chart abstraction process was completed by
  Dr. José Rivera Toledo, Dr. José O.
  Rodríguez, Miss Francheska Méndez and
  Mrs. Sandra Massol.
• Patient data was entered into the PECS registry
  by Mrs. Luz N. Caraballo and Miss Francheska
  Méndez.
• Registration staff members are responsible for
  maintaining data entry updated.

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PSDA CYCLES COMPLETED DAIRY PREWORK

• Clinical Information Generate the patient
  database
• Community Evaluation of the orientation given
  by physician champion for the community of the
  community of the collaboratives.
• Decision Support Evaluate the utilizing of PECS
  and progress notes joined for the clinics.
• Delivery System Organization of the pre-clinic
  function
• ORGHC Evaluation of abstraction process by the
  team

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COMMUNICATION

• How was BOD and staff informed about the health
  centers participation in the Health Disparities
  Collaboratives? The Board of Directors
  and staff were informed about the health centers
  participation in the HDC by the CEO and the
  Medical Director.

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KEY PARTNERSHIPS THAT WILL HELP OUR WORK IN
HEALTH DISPARITIES

• Puerto Rico Department of Health
• Puerto Rico Health Care Primary Association
• Pfizer Pharmaceutical Co.
• Triple S Health Insurance