diabetes data dilemmas: diabetes prevention and control
DESCRIPTION
Diabetes Data Dilemmas: Diabetes Prevention and Control. Kansas Diabetes Quality of Care Project. Seventh Annual Disease Management Colloquium Philadelphia, PA May 8, 2007 Marti Macchi, MEd, Director, Special Studies Kansas Department of Health and Environment - PowerPoint PPT PresentationTRANSCRIPT
Diabetes Data Dilemmas: Diabetes Prevention and Control
Kansas Diabetes Quality of Care Project
Seventh Annual Disease Management ColloquiumPhiladelphia, PA
May 8, 2007Marti Macchi, MEd, Director, Special Studies
Kansas Department of Health and EnvironmentJoe Brisson, Vice President Client Services
Browsersoft
Outline
Project RationaleStatewide ProjectProject ComponentsFirst Year OutcomesData Translated Into PracticeFuture DirectionOpen HRE™ Project
Project RationaleData – Decision Support
Burden of Diabetes in Kansas
2005 – 7.0% Adult Kansans diagnosed with diabetes
7th Leading cause of death (683 Kansans died of diabetes in 2004)
Estimated direct and indirect costs of diabetes were nearly $1.3 billion a year
2004 Kansas Behavioral Risk Factor Surveillance System, KDHE.Center for Health & Environmental Statistics,Office of Vital Statistics KDHE, 2004Lewin Group, Inc., American Diabetes Association,, 2002
Average Yearly Health Care CostUnited States 2002
$13,243
$2,560$0
$2,000$4,000$6,000$8,000
$10,000$12,000$14,000
Person With DiabetesPerson Without Diabetes
Source: Hogan P etal. Economic Cost of Diabetes in the U.S.in 2002. American Diabetes Association. Diabetes Care. 26: 917-932, 2003.
Costs Associated with Poorly Controlled Versus Well
Controlled Diabetes A1c
LevelAdult with Diabetes
Adult with Diabetes, Hypertension & Heart
Disease6% (normal) $8,576 $38,7267% (goal) $8,954 $40,2308% $9,555 $42,4679% $10,424 $45,55710% $11,629 $49,673
Average Medical Care Over 3 Year PeriodSource: Gilmer, Todd P, et al. Diabetes Care 1997; Vol. 20, No. 12.
Kansas Diabetes Prevention & Control Program Objectives
By 2008, increase the rate of:
HbA1c test 69.1 % to 83.0 %Annual foot exam 60.8% to 83.0%
Dilated eye exam 67.5% to 83.0%
Recommended annual pneumococcal immunization
49.3% to 51.6%
Recommended annual influenza immunization
60.7% to 63.5%
Statewide Project
Rawlins
Cheyenne Decatur Norton Phillips Smith JewellRepublic
Washington Marshall NemahaBrown Doniphan
Sherman Thomas Sheridan Graham Rooks Osborne Mitchell
Cloud
Ottawa
Clay
Morton
Wallace Logan Gove Trego Ellis Russell
Lincoln
Ellsworth
Saline
Greeley Wichita Scott Lane NessRush
BartonRice
McPher-son
Hamilton Kearney Finney
Stanton Grant Haskell
Stevens Seward
Gray
Meade Clark
Ford
Hodgeman
Comanche
Kiowa
Edwards
Pawnee
Stafford
Pratt
Reno
Kingman
HarperBarber
Harvey
Sumner
Sedgwick
Cowley
Butler
ChautauquaMont-gomery Labette Cherokee
ElkWilson Neosho
Greenwood
Crawford
Bourbon
Linn
Allen
Miami
Anderson
Franklin
Wood-son
LyonCoffey
Osage
Marion
Chase
Dickinson
Morris
Geary
Waubaunsee
Pottawatomie
Riley Jackson
Shawnee
Atchison
Leavenworth
Douglas Johnson
Jefferson
StaffordReno
Kansas Diabetes Quality of Care Project Sites
Project Organization Demographics
68 funded organizations90 sites statewide350 participating health professionals50% of Kansas’ counties representedDiverse organizations participatingOver 4,000 patients with Diabetes
Types of participating organizations:Local Health DepartmentsCommunity Health ClinicsSafety Net ClinicsAmerican Indian Health ClinicHome Health AgenciesHospital Affiliated PracticesPrivate PracticesFarmworker ProgramPromotora Program
Project Organization Demographics – cont’d
Project Components First Year-----Process
Chronic Care Model TrainingChronic Disease Electronic Management System (CDEMS) TrainingData Entry and AnalysisQuarterly ReportsOffice Protocol Development EncouragedDiabetes Teams EncouragedRegular Team Meetings EncouragedMonthly Conference CallsSite Visits
Project Components
Second Year-----Outcomes Advanced CDEMS TrainingAdvanced Data AnalysisDiabetes Teams EstablishedRegular Team Meetings DocumentedOffice Protocols ImplementedMonthly Conference CallsImproved Quality of Care Measures
The Chronic Care Model
Chronic Care Model Components
Health Care Organization Delivery System DesignDecision SupportSelf-Management SupportCommunity ResourcesClinical Information System
CDEMSHow does it work?
Patient Data Entered
% of Patients ReceivingVaccinations and Foot Exams Needs Improvement
Hard copy insertedinto patient’s chart
Dr. updatespatient’s chart
First Year Outcomes
Health Care OrganizationOutcomes 1st quarter 4th quarter % change
Quantifiable goals for quality of care provided to Patients
45% 66% 46%
Holding routine diabetes team meetings 42% 60% 42%
Organizations Checking Yes on the Quarterly Office Self-Assessment Form
Delivery System DesignOutcomes 1st quarter 4th quarter % change
Routinely ask patients to remove socks and shoes before exam
39% 69% 76%
Non-physician staff allowed to do foot exam 36% 39% 8%All patients scheduled for follow-up 60% 60% -
Non-physician staff empowered to order overdue labs
36% 54% 50%
Non-physician staff empowered to administer flu and pneumonia vaccinations
48% 57% 18%
First Year Outcomes Cont’d….
Organizations Checking Yes on the Quarterly Office Self-Assessment Form
Decision SupportOutcomes 1st quarter 4th quarter % change
CDEMS used to make decisions about needed care for patients
36% 54% 50%
First Year Outcomes Cont’d….
Self-management SupportOutcomes 1st quarter 4th quarter % change
Patients routinely know their targets for blood pressure, finger stick blood sugar, and HbA1
18% 54% 200%
Provide resources for patients to allow them to be full partners in their care
42% 69% 64%
Organizations Checking Yes on the Quarterly Office Self-Assessment Form
Clinical Information SystemsOutcomes 1st quarter 4th quarter % change
Use CDEMS to record patients with eye exams, foot exams, HbA1c, flu and pneumonia vaccinations
45% 75% 66%
Use CDEMS as a reminder system to prompt when a patient is due for labs or visit
27% 42% 55%
First Year Outcomes Cont’d….Community Resources
Outcomes 1st quarter 4th quarter % changeDevelop partnerships in the community for referral
39% 51% 30%
Organizations Checking Yes on the Quarterly Office Self-Assessment Form
0 1 to 23 to 5
6+
14.0
42.6
32.9
10.4
0
10
20
30
40
50
Patia
nt P
erce
ntag
e
Number of Visits
Percentage of Patients by Number of Visits
Patient Office Visits
1st Year Results 2005-2006 - CDEMS Data, Office of Health Promotion (KDHE)
0-1415-29
30-5960+
0.4 2.6
43.949.9
05
101520253035404550
Patie
nt P
erce
ntag
e
Age Group
Percentage of Patients by Age Group
Age Demographics
1st Year Results 2005-2006 - CDEMS Data ,Office of Health Promotion (KDHE)
White AfricanAmerican American
IndianAsian Hispanic Unspecifie
d
73.9
4.70.4 0.3
11.2 8.8
01020304050607080
Patie
nt P
erce
ntag
ePercentage of Patients by Ethnicity
Ethnicity
1st Year Results 2005-2006 - CDEMS Data, Office of Health Promotion (KDHE)
Percentage of Patients by Insurance Type
6.7
28.9
15.8
25.8
7.7
05
101520253035
Medicaid Medicare Commercial Other NoneType of Insurance
Patie
nt P
erce
ntag
e
Insurance
1st Year Results 2005-2006 - CDEMS Data, Office of Health Promotion (KDHE)
<=24 Normal 25-29
Overweight >=30 Obese
-
7.415.9
42.2
010203040506070
Patie
nt P
erce
ntag
e
Body Mass Index Range
Percentage of Patients by Body Mass IndexBody Mass Index
Body Mass Index is defined as weight in kilograms divided by height in meters squared (kg/m2)
1st Year Results 2005-2006 - CDEMS Data, Office of Health Promotion (KDHE)
Comorbidity/Complication Profile of Patients
Comorbidity/Complication Percentage (%)
Hypertension 56.5
Hyperlipidemia 56.3
Heart Disease/Coronary Artery Disease
12.5
Neuropathy 9.6
Nephropathy 4.6
Peripheral Vascular Disease 3.9
Cerebrovascular Disease (stroke) 3.7
Retinopathy 3.5
1st Year Results 2005-2006 - CDEMS Data, Office of Health Promotion (KDHE)
Specialty Care Received
DM Edu.Nutrition Edu.
Smoke cessationSelf Mgt. Goal
Set
28.5
22.8
7.1
16.9
05
101520253035
Patie
nt P
erce
ntag
e
Specialty Care
Percentage of Patients Who Received Specialty Care
1st Year Results 2005-2006 - CDEMS Data, Office of Health Promotion (KDHE)
Preventive Care Practices
A1c Test Flu Vac PneumoVac Foot
Check RetinalExam Self
MoniterBG
75.9
24.1
10.5
51.1
25.721.6
01020304050607080
Patie
nt Pe
rcent
age
Percentage of Patients by Preventive Care Practices
1st Year Results 2005-2006 - CDEMS Data, Office of Health Promotion (KDHE)
HbA1c Levels
<7.0 7.0 - 7.9 8.0 - 8.9 9.0 - 9.9 10 +
38.7
16.3
7.04.3 7.5
0102030405060
Patie
nt P
erce
ntag
e
HbA1c Level (% )
Percentage of Patients by HbA1c Level
1st Year Results 2005-2006 - CDEMS Data, Office of Health Promotion (KDHE)
Data Translated Into Practice- at the clinic level
New office protocols in all organizationsDiabetes patient newslettersPatient certificates for improved A1cPre-visit patient self-assessment programsCDEMS data used to guide team decisions Improved communication among providersSeparate diabetes clinic days establishedPatients made full partners in care
Data Translated Into Practice - at the community level
Pre-Diabetes Screening ProgramsCommunity health fairsChurches Cattle and hog processing plants
New Community PartnershipsYMCAPodiatristsOptometristsDentists
Community Diabetes Education ProgramsTargeting seniorsTargeting overweight/obese
Project Direction
Continue to add organizationsProvide technical assistance to practices to further improvements in diabetes indicatorsCollaborate with other chronic disease programs (Hypertension quality of care project)Explore collecting primary prevention dataExplore interfacing CDEMS with EHROpenHRE™ expansion (Pilot to additional clinics)
OpenHRE™ Pilot Project
Process ProblemMethod of data collection was not efficient (manual spreadsheets)Accuracy of information obtained was affected due to inconsistent data collection and submissionTimeliness to aggregate dataReporting – limited to MS Excel
About OpenHRE™
OpenHRE Community - is a consortium of communities and organizations working together to achieve secure and sustainable Health Record Exchanges.
OpenHRE™ - toolkit consists of three configurable services that connect existing data sources for Health Information Exchange. The OpenHRE™ toolkit is available for download as free, open source software.
OpenHRE™ Pilot Project
Pilot DeploymentCollect data from 5 rural sites representing 13 clinics (1,408 patients)Remove directly identifiable patient dataCreate web-based Diabetes Summary ReportImplement OLAP Reporting
Colby(1 clinic)
Plainville(2 clinics)
Hiawatha(2 clinics)
Ellsworth(5 clinics)
Salina(3 clinics)
ClientApplication*
ClientApplication*
ClientApplication*
ClientApplication*
ClientApplication*
KDHE - Topeka
State of Kansas
* The Client Application is responsible for extracting the data from the site, removing directly identifiable patient information, andtransferring the data to the KDHE server (below)
Kansas Department of Health and EnvironmentCDEMS - PilotBrowsersoft/OpenHRE
Kansas Department of Health and EnvironmentCDEMS - PilotBrowsersoft/OpenHRE
Plainville
Colby
Ellworth
Salina
Hiawatha
ReportingDatabase
KDHE Server running the OpenHRE application.
JPivot BrowserOLAP Application
Tomcat
Mondrian
Diabetes SummaryReport
CDEMSAdapter
Replicated site databases
Diabetes Summary ReportParameters Screen
Diabetes Summary ReportReport Output
OLAP Reporting ToolParameters Screen
OLAP Reporting ToolSample Output
OLAP Reporting ToolSample Graph Output
Problems AddressedProcess Problems
Method of data collection was not efficient (manual spreadsheets)Eliminated manual entry for participating clinics
Accuracy of information obtained was affected due to inconsistent data collection and submission
Automated collection occurs monthly or more frequently if desiredTimeliness to aggregate data
Nightly updates as new data arrivesReporting – limited to MS Excel
Parameter driven Diabetes Summary ReportOLAP tool for Data Analysis
Open source software provides a cost effective deploymentReusabilitySustainable
Contact Information
Marti Macchi, MEdDirector of Special Studies
Kansas Department of Health and Environment
Joe BrissonBrowsersoft, Inc.Vice President of Client Services [email protected]