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Improving Diabetic Care

Dan Isaac, DO
Bishr Alhafez, MD
Alexandra Halalau, MD
Diabetes Mellitus A BIG Problem

Its expensive$245 billion (2012)

Only 9% spent on outpatient management
More focus with ACA and integration of patient centered
medical home on outpatient management and outcome
based reimbersment
ADA Guidelines
Check HbA1c
Good control every 6 months
Poor control/change in regimen every 3 months

Fasting lipid panel
Urine microalbumin
Dilated eye exam
Renal function
Foot exam
Blood pressure monitoring
BMI assessment

Pneumonia (pneumovax and Prevnar)
Influenza (yearly)
How are we doing?
(As of 6/29/15)

Total patients = 870

Average HbA1c = 8.1
BP at goal (<140/90) 62%
Flu shot w/in 1 year 29%
Pneumovax 54%
Foot & eye exam annually 22%
HbA1c checked at appropriate interval 46%
Annual cholesterol 61%
Annual renal function 75%
Annual urine microalbumin 50%
Patient Centered Medical Home
A way of organizing primary care
Emphasizes care coordination and communication
Can lead to higher quality and lower costs.
Practice incentives for qualifying for PCMH offered
by insurance/government
PCMH Qualification Criteria
Clinical Measure Criteria Points
HbA1c >9% <15% of patients 15
HbA1c <8% 65% of patients 10
HbA1c <7% 40% of patients 7
Blood pressure NOT at goal (<140/90) <35% of patients 30
Eye exam annually 60% of patients 12
Foot exam annually 80% of patients 7
Nephropathy assessment 85% of patients 7

Study Plan
Initial data collected and complied for each team for each
measure prior to intervention
Each team along with team attending challenged to
develop method for improving compliance with these
measuresand documentation of completion in EPIC
Data will be collected again 6 months from today
Why should you participate?
The team with the best overall % change will be
awarded $100 per team member
For each PCMH criteria met per team, each team
member will be awarded $10 per member
If your team meets the 70 point PCMH criteria
you will be awarded an additional $30 per
Max prize per team member is $200
Bishr and I will not participate
Dr. Halalaus clinic team will be supervised by Dr.
Thank you Dr. Maddens!