WHAT DOES OUR DIABETES DATA MEAN AND HOW CAN WE

USE IT?

PANEL MEMBERS• Judith Thompson, PharmD, BCPS, CDE, BC-ADM, CDR, USPHS

Alaska Area Diabetes Consultant

• Nancy Haugen, MSN, CNP, PCMH CCE

Great Plains Area Diabetes & Nutrition Consultant

• Monica Giotta, MS, RD/N, CDE

Diabetes Consultant (Contractor) to California Area

• Don Head

Western Tribal Diabetes Project (WTDP) Specialist

Northwest Portland Area Indian Health Board

• Erik Kakuska

Project Specialist WTDP

Northwest Portland Area Indian Health Board

OBJECTIVES OF THIS SESSION

1. Describe the relevance of data for diabetes programs, including both internal and external purposes.

2. Identify resources for working with data within and outside of the Area.

3. Describe how data can help with planning and evaluation.

EXAMPLES OF USES FOR YOUR DIABETES DATA• Clinical care/Quality improvement• Grant applications and reporting• Selecting an SDPI grant Best Practice• Reporting health and other data to the communities you serve• Internal reports for your organization• To determine staffing needs• Program evaluation

IHS WEBAUDIT TOOLS INCLUDE:• Audit report – when finalized, includes all-Area and all-IHS percentages• Trend Graphs• Excel spreadsheets

ADDITIONAL REPORTS/TOOLS FROM AREAS:• Intended to assist your program to improve diabetes care through:

• Evaluating data collection/reporting (to avoid ‘garbage in, garbage out’)• Assist you in understanding what each data measure means• Assessing your data

* such as comparing to your program’s past performance, Area performance, National IHS performance, literature, CDC, etc.

• Structuring processes for improving data measures.== Quality Improvement!

ALASKA AREAJudy Thompson

ALASKA AREA DIABETES PROGRAM

FACILITY DATA, AREA DATA, IHS DATA

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80

100

Your Facility 2016Alaska Avg 2015IHS Avg 2015

FACILITY SPECIFIC DATA OVER TIME

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100

2014

2015

2016

Foot Exam Eye Exam Nutrition Ed. Other DM Ed.

GREAT PLAINS AREANancy Haugen

GREAT PLAINS AREA- DATA DRIVEN DECISIONS • Diabetes Audit Registry- Clean up

• Checklist Process

• Area oversight by registry reports spot checking

• Outcome= 1% improvement in all area measures for Audit17

• Interim IHS Diabetes Audit process- quarterly mandatory for IHS sites

• Checklist Process

• Loaded into WebAudit for area reporting

• Prospective like audit process prior to final audit results

• Facilitates focused opportunities for improvement

• Outcome= Many sites perform now at an increased frequency

GREAT PLAINS AREA

• Sponsor Annual Area Diabetes Management System Training

• Diabetes Data Partnership with Great Plains Tribal Chairman’s Health Board

• GPTEC Diabetes Data Roundtable on April 25-26, 2017• Data Workgroup

• Diabetes Data Project• Use of Checklists

CALIFORNIA AREAMonica Giotta

FY 2017 SDPI Community-Directed GrantSUMMARY of RKM and ActivitiesProgram: XXX Health CenterTime period: January 1, 2017 – December 31, 2017Primary Contact: Jane Smith, RN, CDE

Diabetes Best Practice: Foot ExamsTarget population number/description: 75 AI/AN adults and youth diagnosed with diabetesSDPI Outcomes System (SOS) Entry method: 2017 Interim Web AuditSOS Baseline: 22/75 = 29%

Required Key Measure (RKM): Number and percent of individuals in your Target Group who receive a comprehensive foot exam.**A foot exam includes assessment of sensation and vascular status.

Best Practice Activities:1. By 1/31/17, create a SDPI Target Group and save to a new RPMS SDPI Register.2. Follow health center policies and procedures that adhere to IHS Standards of Care and Clinical Practice Recommendations for foot care.3. Use pre-visit planning to identify patients needing an annual foot exam and perform according to protocol.4. Assign a category of foot risk for each patient and record in EHR with notification of Case Manager.

D O N H E A D & E R I K K A K U S K AW E S T E R N T R I B A L D I A B E T E S P R O J E C T

N O R T H W E S T P O R T L A N D A R E A I N D I A N H E A L T H B O A R D

Portland Area

Portland Area Health Status Report� Resolution from the Northwest Portland Area

Health Board to receive Audit data, and report back to the Tribes through the HSR

� Western Tribal Diabetes Project has Audit data for the SPDI programs going back to 2003 or 2004, depending on program

� The HSR is sent to NPAIHB Delegates, Tribal Health Directors, and Diabetes Coordinators

Portland Area Health Status Report - Trends

2004 2014 2015 2016 2017Charts audited 3877 6832 7534 6699 7075Total active on register 4986 8004 8021 7109 7608

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Patients in the Diabetes Register

Hemoglobin A1c Trends

2004(n=3877)

2014(n=6832)

2015(n=7534)

2016(n=6699)

2017(n=7075)

HbA1cmissing 11 % 7 % 16 % 7 % 5 % HbA1c10.0orhigher 13 % 17 % 15 % 17 % 19 % HbA1c7.0-9.9 37 % 37 % 33 % 39 % 41 %

HbA1c<7 39 % 39 % 37 % 38 % 35 % HbA1c≤6.5 28 % 30 % 29 % 27 % 25 %

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HemoglobinA1c

2014(n=6407)

2015(n=6987)

2016(n=6239)

2017(n=6735)

MeanHbA1c 7.96 7.84 7.99 8.17Standarderror 0.09 0.08 0.08 0.0795%CIupperlimit 8.137 7.995 8.150 8.31395%CIlowerlimit 7.789 7.691 7.827 8.028

0123456789

10

AverageHemoglobinA1C

Diabetes-Related Education Trends

2004(n=3877) 2014(n=6832) 2015(n=7534) 2016(n=6699) 2017(n=7075) Dieteducation,anyprovider 51 % 50 % 51 % 58 % 59 % Dieteducation,RDonly 25 % 18 % 12 % 18 % 17 % Exerciseeducation 41 % 48 % 30 % 60 % 61 % Otherdiabeteseducation 51 % 67 % 36 % 67 % 69 % Anyofthelistedtopics 78 % 65 % 83 % 85 %

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Diabetes-RelatedEducation

Portland Area Health Status Report -Comparison

4558 5101 5352 6661 6788 7513 7608

1109012316

19212

25593

40175

*TheAuditperformedin2017coversservicesdeliveredin2016

Active Patients with Diabetes in the 2017 IHS Diabetes Audit

Portland Area and All IHS Areas

Activeregisterpatientsnotsampled,ordiagnosedafter2016

Patientssampledforaudit

Labelsshowtotalnumbersofactiveregisterpatients

Hemoglobin A1c - Comparison

PortlandArea AllIHSAreas

HbA1c<7.0 35 % 33 %

HbA1c7.0- 9.9 41 % 43 % HbA1c≥10.0 19 % 18 % HbA1cnotestorresult 5 % 6 %

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HemoglobinA1C

Tobacco Use & Cessation Counseling

PortlandArea(n=2358Patients)

AllIHSAreas(n=29957Patients)

Counseled- Yes 66 % 66 %

0 %

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40 %

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80 %

100 %

TobaccoCessationCounselingforCurrentTobaccoUsers

PortlandArea AllIHSAreasCurrenttobaccouser 33 % 24 % Notacurrenttobacco

user 64 % 73 %

Tobaccousenotdocumented 2 % 3 %

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100 %

TobaccoUseTobacco use increases the already elevated

risk of cardiovascular and microvascular complications in

people with diabetes. Research shows that a

brief tobacco dependence treatment intervention delivered

by one provider can increase quit rates by

as much as 80%.

Health Status Report – NPAIHB Website

Health Status Report Excel File

SUMMARY• Do your best to understand your diabetes data• Don’t be shy about asking Area staff any questions you have• Accurate data are very powerful

• Where are we now? Where do we want to be?• Discover ways to tell a story with your data

CONTACT INFORMATION

• Judy Thompson JBThompson@anthc.org• Nancy Haugen Nancy.Haugen@ihs.gov• Monica Giotta Mgiotta@cox.net• Don Head DHead@npaihb.org• Erik Kakuska EKakuska@npaihb.org