Working Together to "Weaken the Link" between Cardiovascular Disease and Diabetes. Kim Headspeth, BSHIM, MHA Nancy Semrau, RN, BSBA, MHI

Transcription

1 Working Together to "Weaken the Link" between Cardiovascular Disease and Diabetes Kim Headspeth, BSHIM, MHA Nancy Semrau, RN, BSBA, MHI November 10, 2016

2 Objectives Improve cardiovascular health - Promote use of standardized blood pressure 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 and referring patients to education and support at four critical times, and having 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, and success stories are shared to promote sustainable quality improvement. 2

3 atom Alliance Multi-state alliance for powerful change composed of three nonprofit, healthcare QI consulting companies. 3

4 Diabetes and Cardiovascular Disease (CVD) Link 1American Diabetes Association website (Accessed 04/19/16) 2American Heart Association website 4 Disease-Diabetes_UCM_313865_Article.jsp#.VxYkhdFwXIU (Accessed 04/19/16)

5 Diabetes and CVD Link (cont.) 3Kentucky Department for Public Health 2016 Kentucky Diabetes Fact Sheet. Accessed 10/05/16. 5

6 6 Improve Cardiovascular Health

7 Why Use Blood Pressure Protocols. 7 SOURCE: American Heart Association

8 Why Use Blood Pressure Protocols (cont.) Elements Associated with Effective Adoption and 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 key to 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. 8 SOURCE: National Health and Nutrition Examination Survey

9 Why Standardized Treatment Protocols are Important Inpatients with HTN with systolic BPs >150 mm HG, increased risk of acute cardiovascular events or death can occur with: Delays in medications intensification >6 weeks Delays in follow-up appointments >10 weeks after medication intensification. 9 SOURCE: American Heart Association

10 10 Staff Involvement

11 How to Implement Blood Pressure Protocols in Your Setting Team-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. 11

12 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, such as ensuring that patients bring in their home readings and ask questions or express concerns, including about access to medications and monitoring 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. 12

13 13 Patient Engagement

14 Where to Find Sample Protocols Resource to Support the Implementation of Hypertension Protocols Sample Protocols Million Hearts American Heart Association Kaiser Permanente New York City Health and Hospitals Corporation Veterans Affairs/Department of Defense Institute for Clinical Systems Improvement Template for providers to create a hypertension treatment protocol Modifiable form 14

15 15

16 Improving Cardiac Health and Reducing Cardiac Healthcare Disparities Taken from: 16

17 Improving Cardiac Health and Reducing Cardiac Healthcare Disparities and Cost fo C r ard K iov e as n cu t la u r D c iseas ky e accounted for 15 percent (89,537) of all hospitalizations in Kentucky in The cost for Cardiovascular Disease in the United States was projected to 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: 17

18 18 Cardiac in Kentucky

19 Million Hearts Initiative Support the Department for Health and Human Services (HHS) Million Hearts Initiative Prevent one million heart attacks and strokes by 2017 by focusing on the ABCS A =Aspirin when appropriate B = Blood pressure control C = Cholesterol management S = Smoking cessation Help providers and home health agencies (HHAs) improve use of HIT to capture and improve quality of care and patient outcomes 19

20 Key Components of Million Hearts Keeping Us Healthy Changing the environment Health Disparities Excelling in the ABCS Optimizing care Focus on the ABCS Health tools and technology TRANS FAT Innovations in care delivery Glantz. Prev Med. 2008; 47(4): How Tobacco Smoke Causes Disease: A Report of the Surgeon General,2010.

21 21 Diabetes

22 U.S. Prevalence of Diagnosed Diabetes 22 Centers for Disease Control and Prevention. Diabetes Interactive Atlas Web site Accessed 10/05/16.

23 Kentucky Prevalence of Diagnosed Diabetes 23 Centers for Disease Control and Prevention. Division of Diabetes Translation. US Diabetes Surveillance System( Available at Accessed 10/17/16.

24 Kentucky Diabetes Facts for Public Health 2016 Kentucky Diabetes Fact Sheet. nfo/dpqi/cd/diabetesfactsheets.htm. Accessed 10/05/ Kentucky Department 2CDC, National Center forhealthstatistics. Diabetes MortalitybyState, 2014: Accessed 10/05/16. 3CDC, National Center forhealthstatistics. Stats of the State ofkentucky, 2014: 4CDC. National Diabetes Statistics Report,

25 Medicare Diabetes: Prevalence or this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, 25 Information f Government Task Leader, CMS Health Disparities Program, gave on 11/14/14 1Source: CMS Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition 2Source: 2013 testimony by the Congressional Diabetes Caucus in the US House of Representatives and the American Diabetes Association)

26 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 million Americans) have diabetes and account for about 32 percent of Medicare spending Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14 1Source: CMS Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition 2Source: 2013 testimony by the Congressional Diabetes Caucus in the US House of Representatives and the American Diabetes Association)

27 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/Native American and Asian/Pacific Islander). 27 Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

28 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 and Weight control. Facilitate sustainable diabetes education by engaging in public/private agency/organization partnerships at the community, state and national levels. 28 Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

29 EDC Components EDC 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/implementation EDC is a continuous plan/do/study/act (PDSA) cycle; keep or tweak 29 Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

30 Accomplishing the Goals of EDC Recruit, enroll, and teach people with Medicare utilizing a Centers for Medicare & 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 30

31 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 31 Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

32 Accomplishing the Goals of EDC (Cont.) 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) program recognition for Medicare Diabetes Self-Management Training (DSMT) billing 32 Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

33 Accomplishing the Goals of EDC (Cont.) Recruit local, state, and national partners and stakeholders Mutual dissemination of aligned tools, resources, and program information Collaborate on Utilize Data the Train-the-Trainer and sustainability plans 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 EDC initiative 33 Information for this slide is from the AADE Webinar presentation Susan Fleck, RN, MMHS, Government Task Leader, CMS Health Disparities Program, gave on 11/14/14

34 34 DSME Program

35 Diabetes Empowerment Education Program (DEEP) University of Illinois at Chicago Midwest Latino Health Research Training and Policy Center Learning We Remember: o of what we read Developed to provide community residents with the tools to better manage their diabetes in order to reduce complications and lead healthier, longer lives. Based on principles of empowerment and adult education of what we hear of what we see of what we see and hear of what we do 35

36 DEEP DSME Modules Understanding the Human Body Exercises to establish trust and solidarity Systems and organs diabetes affects Description of what diabetes does to the Organs What is Diabetes Diabetes defined Risk factors Signs and symptoms of diabetes 36

37 DEEP DSME Modules Monitoring Your Body Teach signs, symptoms, and monitoring of hypoglycemia and hyperglycemia and ways to monitor Teach diabetes management using glucose meter Get Up and Move: Diabetes and Exercise Teaching physical activity as a method to control diabetes Making time for regular physical activity 37

38 DEEP DSME Modules (Cont.) Nutrition Basic nutritional concepts How to read food labels (calories) carbohydrates, salt, and trans fats MyPlate method and food portions 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 38

39 DEEP DSME Modules (Cont.) Introduction to Medications Medications for control of diabetes, hypertension and cholesterol Medications actions, cautions, and side effects Self-management care guides Coping with Diabetes Emotional aspects of diabetes (e.g., stress, depression and patients rights) Involving family and friends in care management 39

40 I m Eating What! 40 Visual representation of the amount of sugar and fat in a typical fast food meal. Photo taken by Nancy Semrau, Quality Improvement Advisor

41 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 dropped since starting the class, and others indicated they had increased how much they exercise Multiple people stated that as a result of the class, they got recommended examinations, such as eye and foot exams 41

42 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 handson and visual activities Many people stated they enjoyed the sharing that occurred between participants Many participants stated they changed their meal portion sizes and preparation and started reading food labels. 42

43 Participant Testimonials. atom Alliance. What Participants Are Saying About atom Alliance s Diabetes Self- Management Education (DSME) Program in Kentucky. Web site: Accessed 43 10/18/16.

44 DSME/S Algorithm of Care American Association of Diabetes Educators. Diabetes Self-Management Education and Support for Adults with Type 2 Diabetes: Algorithm of Care Web site 44 source/practice/algorithm-of-care.pdf?sfvrsn=2. Accessed 10/11/16.

45 Medical Nutrition Therapy Telligen, Medicare QIN-QIO National Coordinating Center. Medicare DSMT and MNT Requirements for Reimbursement. Accessed at 45 reimbursement/. Accessed 10/11/16.

46 Partner/Stakeholder Testimonial 46 atom Alliance. Improving Diabetes Outcomes in Kentucky. Web site Accessed 10/11/16.

47 Becoming a Part of EDC People with Medicare and diabetes Attend diabetes education and encourage other people with Medicare and diabetes to attend classes Partners and Stakeholders Contact the QIN-QIO to discuss potential collaborations related to increasing diabetes educators and/or diabetes education sites and spreading 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 47

48 48 Learning and Action Network

49 Learning and Action Networks A Learning and Action Network (LAN) is a quality improvement collaborative that creates achievable rapid, wide-scale improvement by bringing 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 brightest healthcare leaders sharing stories, expertise and advice on how to improve 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. 49

50 You Will Be A Part of the LAN Since September 2015, more than 3,100 participants have attended one or more of our LANs Since 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. 50

51 You Will Be A Part of the LAN (cont.) Hot Topics MACRA Welcome to Medicare visit NHSN enrollment and reporting Interviewing the intellectually and developmentally disabled Infections Patient engagement Future Topics 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 51

52 LAN On-Demand Learning 52 atom Alliance. On-Demand Learning Web site Accessed 10/05/16.

53 Kentucky atom Alliance Team Tammy Geltmaker, RN, BSN, MHA Kentucky Quality Program Director (502) Lyn Adiutori Health Information Technology Specialist (502) Kim Headspeth, BSHIM, MHA Quality Improvement Advisor (270) Kristin Hennette, BS, CHTS-PW Health Information Technology Specialist (502) Nancy Semrau, RN, BSBA, MHI Quality Improvement Advisor (502) Cindy Todd, MSN, RN Quality Improvement Advisor (502) Margie Banse, BA Quality Data Reporting Manager (502)

54 Kentucky atom Alliance Team (Cont.) Janet Pollock, BA Community Manager (502) Scott Gibson, BA Quality Improvement Advisor (502) Kibibi Wood-Montgomery, CSW Quality Improvement Advisor Health Information Technology Advisor (502) Mary Bardin, RN Quality Improvement Advisor (270) Mark Bush, RN Quality Improvement Advisor Health Information Technology Advisor (502) Pat Pope, CPHIE Practice Solution Advisor (423) Carolyn Hare, RN, ARNP Quality Improvement Advisor (606)

55 Thank You Questions? Kim Headspeth, BSHIM, MHA Quality Improvement Advisor (270) Nancy Semrau, RN, BSBA, MHI Quality Improvement Advisor (502)

56 For More Information Visit new Website for details www. atomalliance.org 56

57 Connect with Us Reminders Facebook malliance Twitter lliance LinkedIn any/atom-alliance Pinterest alliance/ This material was prepared by atom Alliance, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO), coordinatedbyqsource fortennessee, Kentucky, Indiana, Mississippi andalabama, under acontract with the Centers formedicare & MedicaidServices (CMS), anagency of the U.S. Department of Healthand HumanServices. Content presented does not 57 necessarily reflectcms policy. 16.SS.KY.B