working together to weaken the link - microsoft...chicago midwest latino health research training...

Kim Headspeth, BSHIM, MHANancy Semrau, RN, BSBA, MHI

November 10, 2016

Working Together to "Weaken the Link" betweenCardiovascular Disease and Diabetes

Objectives

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• Improve cardiovascular health - Promote use of standardized bloodpressure protocols for every patient encounter and discussion, which empower patients to know their "ABCS" to enhance quality of care.

• Reduce disparities in diabetes care - Emphasize the importance of identifying those at risk, monitoring data regularly, assessing andreferring patients to education and support at four critical times, andhaving designated staff trained to facilitate the concepts of diabetes self-management.

• Increase participation in Learning and Action Network (LAN) activities - Encourage involvement in an "all teach, all learn" environment where barriers, lessons learned, best practices, andsuccess stories are shared to promote sustainable quality improvement.

atom AllianceMulti-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies.

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Diabetes and Cardiovascular Disease (CVD) Link

1American Diabetes Association website http://www.diabetes.org/living-with-diabetes/complications/heart-disease/ (Accessed 04/19/16)2American Heart Association websitehttp://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-

4 Disease-Diabetes_UCM_313865_Article.jsp#.VxYkhdFwXIU (Accessed 04/19/16)

Diabetes and CVD Link (cont.)

3Kentucky Department for Public Health 2016 Kentucky Diabetes Fact Sheet.http://chfs.ky.gov/dph/info/dpqi/cd/diabetesfactsheets.htm. Accessed 10/05/16.

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Improve Cardiovascular Health

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Why Use Blood Pressure Protocols

.

SOURCE: American Heart Association7

Why Use Blood Pressure Protocols (cont.)

Elements Associated with Effective Adoptionand Use of a Protocol

Evidence-based treatment protocols are an essential tool for improving blood pressure control among practices and health care systems.

Million Heart Stakeholders recognize that the use of protocols is keyto their success in blood pressure control.

Stakeholders consist of protocol owners, key organizations and health care providers who have successfully used protocols within their system.

8SOURCE: National Health and Nutrition Examination Survey 2011-2012.

Why Standardized Treatment Protocols are Important

.

Inpatients with HTN with systolic BPs >150 mm HG, increased riskof acute cardiovascular events or death can occur with:

Delays in medications intensification >6 weeks

Delays in follow-upappointments >10 weeks after medication intensification

SOURCE: American Heart Association9

Staff Involvement

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How to Implement Blood Pressure Protocols in Your SettingTeam-Based Care Approach:

Make hypertension control a priority.

Fully use the expertise and scope of practice of every member of the health care team: physician, advanced practice nurse, physician’s assistant, nurse, hospital and community pharmacist, medical assistant, care coordinator, and others.

Include the patient and family as key members of the team.

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How to Implement Blood Pressure Protocols in Your Setting (cont.)

Team-Based Care Approach:Conduct pre-visit planning to make the most of the care encounter, suchas ensuring that patients bring in their home readings and ask questions or express concerns, including about access to medications andmonitoring equipment, adverse effects of medications, and challenges with diet and exercise.

Learn about community resources and recommend them to patients.

When hypertension is not controlled, look for opportunities to check in with patients between visits and adjust medication dose as needed.

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Patient Engagement13

Where to Find Sample ProtocolsResource to Support the Implementation of Hypertension Protocols

Sample ProtocolsMillion HeartsAmerican Heart Association

Kaiser Permanente

New York City Health and Hospitals Corporation

Veterans Affairs/Department of Defense

Institute for Clinical Systems ImprovementTemplate for providers to create a hypertension treatment protocol

Modifiable form

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Improving Cardiac Health and Reducing Cardiac Healthcare Disparities

Taken from: http://chfs.ky.gov/dph/info/dpqi/cd/heart+disease+and+stroke+prevention.htm 16

Improving Cardiac Health and ReducingCardiac Healthcare Disparities and Cost foCrardKioveasncutlaur Dciseaskye accounted for 15 percent (89,537) of all

hospitalizations in Kentucky in 2010.

The cost for Cardiovascular Disease in the United States was projectedto be $444 billion in 2010 including health care expenditures and lost of productivity from death and disability.

The 2010 Kentucky inpatient hospitalization for all cardiovascular related disease totaled over $3.2 billion.

Taken from: http://chfs.ky.gov/dph/info/dpqi/cd/heart+disease+and+stroke+prevention.htm

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Cardiac in Kentucky

Million Hearts InitiativeSupport the Department for Health and Human Services (HHS) Million Hearts® InitiativePrevent one million heart attacks and strokes by 2017 by focusing ontheABCS

• A =Aspirin when appropriate• B = Blood pressure control• C = Cholesterol management• S = Smoking cessation

Help providers and home health agencies (HHAs) improve use of HITto capture and improve quality of care and patient outcomes

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Key Components of Million Hearts®

Excelling in theABCSOptimizing care

Focus on theABCS

Health toolsand technology

Innovations incare delivery

Keeping Us HealthyChanging the environment

TRANSFAT

Health Disparities

Glantz. Prev Med. 2008; 47(4): 452-3.How Tobacco Smoke Causes Disease: A Report of the Surgeon General,2010.

Diabetes

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U.S. Prevalence of Diagnosed Diabetes

Centers for Disease Control and Prevention. Diabetes Interactive Atlas Web sitehttp://www.cdc.gov/diabetes/atlas/. Accessed 10/05/16.

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Kentucky Prevalence of Diagnosed Diabetes

Centers for Disease Control and Prevention. Division of Diabetes Translation. US DiabetesSurveillance System(http://www.cdc.gov/diabetes/data/index.html). Available athttp://www.cdc.gov/diabetes/data. Accessed 10/17/16.

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Kentucky Diabetes Facts

1Kentucky Departmenthttp://chfs.ky.gov/dph/i2CDC, National Center for Health Statistics. Diabetes Mortality by State, 2014:http://www.cdc.gov/nchs/pressroom/states/kentucky.htm. Accessed 10/05/16. 3CDC, National Center for Health Statistics. Stats of the State of Kentucky, 2014:

for Public Health 2016 Kentucky Diabetes Fact Sheet. nfo/dpqi/cd/diabetesfactsheets.htm. Accessed 10/05/16.

http://www.cdc.gov/nchs/pressroom/states/kentucky.htm.4CDC. National Diabetes Statistics Report, 2014. http://www.cdc.gov/diabetes/home/index.html.24

Medicare Diabetes: Prevalence

or this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS,

Information fGovernment Task Leader, CMS Health Disparities Program, gave on 11/14/141Source: CMS Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition2Source: 2013 testimony by the Congressional Diabetes Caucus in the US House ofRepresentatives and the American Diabetes Association)25

Medicare Diabetes:Prevalence and Expenditures (cont.)

People who are dually eligible (those with both Medicare and Medicaid coverage) are 1.4 times more likely to have diabetes.1

Twenty-seven percent of people with Medicare age 65+ (10.9 millionAmericans) have diabetes and account for about 32 percent of Medicare spending.2

Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS,Government Task Leader, CMS Health Disparities Program, gave on 11/14/141Source: CMS Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition2Source: 2013 testimony by the Congressional Diabetes Caucus in the US House ofRepresentatives and the American Diabetes Association)26

Everyone With Diabetes Counts (EDC) Initiative Goals

Improve health equity by improving health literacy and quality of care among people with Medicare with diabetes through knowledge empowerment and enabling them to become active participants in their care (patient engagement).

EDC is a disparity reduction program. Target populations are dual eligible, rural, lower socioeconomic status, or minority underserved(African American, Hispanic/Latino,American Indian/NativeAmericanand Asian/Pacific Islander).

Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, GovernmentTask Leader, CMS Health Disparities Program, gave on11/14/1427

Everyone With Diabetes Counts (EDC) Initiative Goals (cont.)

Engage both people with Medicare and health care providers to decrease the disparity in diabetes by improving testing and clinical outcomes for HbA1c, Lipids, Eye and Foot Exams, and to improve Blood Pressure andWeight control.

Facilitate sustainable diabetes education by engaging in public/privateagency/organization partnerships at the community, state and nationallevels.


EDC ComponentsEDC’s five components• Recruitment and education of people with Medicare• Education of participating physician practices and staff• Recruitment of partners/stakeholders• Data collection and analysis• Sustainability planning/implementationEDC is a continuous plan/do/study/act (PDSA) cycle; “keep or tweak”

Information for this slide is from the AADE Webinarpresentation Susan Fleck, RN, MMHS, GovernmentTask Leader, CMS Health Disparities Program, gave on11/14/1429

Accomplishing the Goals of EDCRecruit, enroll, and teach people with Medicare utilizing a Centers forMedicare & Medicaid Services (CMS)-approved evidence-based Diabetes Self-Management Education (DSME) program• Provide free DSME courses

• Six consecutive weeks• One class a week• Two hours each session• Hands on/visual activities and examples• Graduation/participation certificate and ceremony• Family members or care-givers encouraged to attend

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Accomplishing the Goals of EDC (Cont.)

Increase the number of diabetes educators, certified diabetes educators (CDEs), community health workers (CHWs), and certified diabetes education sites in Kentucky



Work with participating practices• Improve adherence to standards of care for people with diabetes• Improve provider data collection and data analysis skills• Improve use of electronic health records (EHRs)• Educate practice staff• Provide technical assistance to interested practices

• Train-the-Trainer program• American Association of Diabetes Educators (AADE) program

accreditation/American Diabetes Association (ADA) programrecognition for Medicare Diabetes Self-Management Training(DSMT) billing



Recruit local, state, and national partners and stakeholders• Mutual dissemination of aligned tools, resources, and program

information•Collaborate on the Train-the-Trainer and sustainability plans Utilize Data

• Quality Innovation Network-Quality Improvement Organization(QIN-QIO) will obtain clinical results of diabetes measures for 10 percent of people with Medicare who complete DSME

• CMS will match the data to Medicare claims data• Allows for following data of people with Medicare

longitudinally over time to view the impact of the EDCinitiative


DSME Program

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Diabetes Empowerment Education Program (DEEP)

University of Illinois at Chicago Midwest LatinoHealth Research Trainingand Policy Center

Developed to provide community residents with the tools to better manage their diabetes in order to reduce complications andlead healthier, longer lives.

Based on principles of empowerment and adult education

LearningWe Remember:

of what we read

of what we hear

of what we see

of what we see and hear

o

of what we do

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DEEP DSME ModulesWhat is Diabetes• Diabetes defined• Risk factors• Signs and symptoms of

diabetes

Understanding the HumanBody• Exercises to establish trust

and solidarity• Systems and organs diabetes

affects• Description of what diabetes

does to the Organs

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DEEP DSME ModulesGet Up and Move: Diabetes and Exercise• Teaching physical activity as

a method to control diabetes• Making time for regular

physical activity

Monitoring Your Body• Teach signs, symptoms, and

monitoring of hypoglycemiaand hyperglycemia and waysto monitor

• Teach diabetes management using glucose meter

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DEEP DSME Modules (Cont.)

Nutrition• Basic nutritional concepts• How to read food labels

(calories) carbohydrates, salt, and trans fats

• MyPlate method and foodportions

• Exercises on salt and fat hidden in food

Preventing Diabetes Complications• Smoking and circulatory

problems• The importance of daily foot

care• Reporting abnormalities to

providers• Visiting different specialists

for prevention and control

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DEEP DSME Modules (Cont.)

Introduction to Medications Coping with Diabetes

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• Medications for control of •diabetes, hypertension andcholesterol

• Medications actions, cautions, and side effects

• Self-management care guides

Emotional aspects of diabetes (e.g., stress, depression and patients’ rights)

• Involving family and friends in care management

I’m Eating What!

Visual representation of the amount of sugar and fat in a typical fast food meal. Photo taken by Nancy Semrau, Quality Improvement Advisor

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What Participants Are Saying about atom Alliance’s DSME Program

Participant feedback from DEEP courses• A couple of people who have had diabetes for years thought they would

not learn a lot but stated they did

• Multiple participants indicated their blood sugar levels had droppedsince starting the class, and others indicated they had increased howmuch they exercise

• Multiple people stated that as a result of the class, they got recommended examinations, such as eye and foot exams

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What Participants Are Saying about atom Alliance’s DSME Program (cont.)

Participant feedback from DEEP courses• Many participants stated they enjoyed and learned a lot from the hands-

on and visual activities

• Many people stated they enjoyed the sharing that occurred betweenparticipants

• Many participants stated they changed their meal portion sizes andpreparation and started reading food labels.

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Participant Testimonials

. atom Alliance. What Participants Are Saying About atom Alliance’s Diabetes Self-Management Education (DSME) Program in Kentucky. Web site:http://atomalliance.org/download/ky-dsme-testimonials-booklet/. Accessed

43 10/18/16.

DSME/S Algorithm of Care

American Association of Diabetes Educators. Diabetes Self-ManagementEducation and Support for Adults with Type 2 Diabetes: Algorithm ofCare Web site https://www.diabeteseducator.org/docs/default-

44 source/practice/algorithm-of-care.pdf?sfvrsn=2. Accessed 10/11/16.

Medical Nutrition Therapy

Telligen, Medicare QIN-QIO National Coordinating Center. Medicare DSMT and MNT Requirements for Reimbursement. Accessed athttp://atomalliance.org/download/medicare-dsmt-mnt-requirements-

45 reimbursement/. Accessed 10/11/16 .

Partner/Stakeholder Testimonial

atom Alliance. Improving Diabetes Outcomes in Kentucky. Web sitehttp://atomalliance.org/download/improving-diabetes-outcomes-kentucky/.Accessed 10/11/16.46

Becoming a Part of EDCPeople with Medicare and diabetes• Attend diabetes education and encourage other people with Medicare

and diabetes to attend classesPartners and Stakeholders• Contact the QIN-QIO to discuss potential collaborations related to

increasing diabetes educators and/or diabetes education sites andspreading aligned tools, information, and resources

Providers• Host DSME courses• Refer people with diabetes to DSME classes• Contact us to learn more about free QIN-QIO assistance in training

appropriate staff to facilitate DEEP DSME courses and/or becoming a certified diabetes education site for Medicare billing of DSMT

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Learning and Action Network

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Learning and Action NetworksA Learning and Action Network (LAN) is a quality improvement collaborative that creates achievable rapid, wide-scale improvement bybringing together healthcare professionals, patients and other stakeholders to focus on an evidence-based agenda.Participants have access to some of the nation’s best and brightesthealthcare leaders sharing stories, expertise and advice on how toimprove care.We would like you to be involved in our LAN events.• There are On–Demand recordings and upcoming LAN events in

which we would like your participants to watch.

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You Will Be A Part of the LANSince September 2015, more than 3,100 participants have attended one or more of our LANsSince February 2016, more than 900 participants from 29 states have

accessed our On-Demand Learning (ODL) sessions. Topics include:

• Data Reporting Guidelines

• Patient Engagement

• Diabetes Management

• NHSN Enrollment

Nearly 20,000 people have subscribed to our monthly e-newsletter.

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You Will Be A Part of the LAN (cont.)

• Managing depression in a

primary care clinic

• MIPS (Merit-based Incentive

Payment System)

• Meeting MU requirements

• Tobacco cessation• Mental health issues with

comorbid chronic health

conditions

• Annual wellness visits

Hot Topics Future Topics

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• MACRA

• Welcome to Medicare visit• NHSN enrollment and

reporting

• Interviewing the intellectually

and developmentally disabled

• Infections

• Patient engagement

LAN On-Demand Learning

atom Alliance. On-Demand Learning Web site http://atomalliance.org/webinars/on-demand-webinars/. Accessed 10/05/16.

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Kentucky atom Alliance TeamKristin Hennette, BS, CHTS-PWHealth Information Technology Specialist [email protected](502) 680-2721

Nancy Semrau, RN, BSBA, MHI Quality Improvement Advisor [email protected](502) 680-2391

Cindy Todd, MSN, RN Quality Improvement Advisor [email protected](502) 680-2954

Tammy Geltmaker, RN, BSN, MHA Kentucky Quality Program Director [email protected](502) 680-2746

LynAdiutoriHealth Information Technology Specialist [email protected](502) 216-6264

Kim Headspeth, BSHIM, MHA Quality Improvement Advisor [email protected](270) 832-4563

Margie Banse, BAQuality Data Reporting [email protected](502) 680-2857

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Kentucky atom Alliance Team (Cont.)

Janet Pollock, BA Community [email protected](502) 680-2819

Scott Gibson, BAQuality Improvement Advisor [email protected](502) 680-2669

Kibibi Wood-Montgomery, CSW Quality Improvement AdvisorHealth Information Technology Advisor [email protected](502) 381-5792

Carolyn Hare, RN, ARNP Quality Improvement Advisor [email protected](606) 303-5007

Mary Bardin, RNQuality Improvement Advisor [email protected](270) 605-4022

Mark Bush, RNQuality Improvement AdvisorHealth Information Technology Advisor [email protected](502) 649-5369

Pat Pope, CPHIE PracticeSolution [email protected](423) 557-3356

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Thank YouQuestions?

Kim Headspeth, BSHIM, MHAQuality Improvement Advisor(270) 832-4563 | [email protected]

Nancy Semrau, RN, BSBA, MHI Quality Improvement Advisor(502) 680-2391 | [email protected]

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For More InformationVisit nwww.

ew Website for details atomAlliance.org

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Connect with Us Reminders

Facebookwww.facebook.com/atomalliance

57 necessarily reflect CMS policy. 16.SS.KY.B2.10.006

Twitterwww.twitter.com/atom_alliance

LinkedInwww.linkedin.com/company/atom-alliance

Pinterestwww.pinterest.com/atomalliance/

This material was prepared by atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinated by Qsource for Tennessee, Kentucky, Indiana, Mississippi and Alabama, under a contract with the Centers for Medicare& Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Content presented does not

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