Donna Amundson, RN, BSN, CDE Director of the Sanford Diabetes Center Bismarck, ND

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1 Donna Amundson, RN, BSN, CDE Director of the Sanford Diabetes Center Bismarck, ND

2 Discuss the core principles of quality management for diabetes care and education Identify the 6 core elements of the Chronic Care Model Discuss strategies for system-level improvement

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5 Approximately 21 million Americans live with diabetes Cost to Americans in 2012 was $245 billion The personal costs for patients with poorly controlled diabetes are immeasurable.

6 Approximately 21 million Americans live with diabetes Cost to Americans in 2012 was $245 billion!! The personal costs for patients with poorly controlled diabetes are immeasurable.

7 The prevalence of diagnosed diabetes among adults (18 and older) in North Dakota has increased over the past 10 years, from 5.9% in 2004 to 8.6% in North Dakota s rising prevalence has paralleled the national trend for diabetes. Diabetes in North Dakota 2016 Report to the Legislative Management

8 An estimated 49,159 adults in North Dakota were living with diagnosed diabetes. An additional 18,961adults had undiagnosed diabetes. An estimated thirty seven percent of the total population has pre-diabetes, which translates to over 202,196 people in North Dakota Diabetes in North Dakota 2016 Report to the Legislative Management

9 The total North Dakota population affected by elevated glucose (diagnosed and undiagnosed diabetes + estimated prediabetes) = 270,316 people. Diabetes in North Dakota 2016 Report to the Legislative Management

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12 Steady improvement has been shown More patients with diabetes have been treated with statins More have achieved recommended A1C, blood pressure and LDL cholesterol goals. Between 1999 and 2002, mean A1C nationally among people with diabetes was 7.6%. From 2007 to 2010, it decreased to 7.2%. NHANES (National Health and Nutrition Examination Survey)

13 33 49% of patients still do not meet the targets for glycemic, blood pressure or cholesterol control, and only 14% meet targets for all three measures, while also avoiding smoking. Persistent variability in the quality of diabetes care across providers and practice settings exists.

14 System level Patient level

15 Evidenced based practice recommendations and clinical practice guidelines, are intended to guide providers with an overall approach to care However, one size does not fit all. Care needs to be respectful of and responsive to individual patient preferences, needs, and values.

16 Delivery system design Self-management support Decision support Clinical information systems Community resources and policies Health systems

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18 Optimize provider and team behavior Support patient self-management Change the care system

19 Optimize provider and team behavior Support patient self-management Change the care system

20 Team must include the patient Should prioritize timely and appropriate intensification of lifestyle and/or pharmacologic therapy Assess medication adherence Set goals with patients Identify patient barriers Use evidence based guidelines and clinical information tools Solicit performance feedback Incorporate care management teams

21 Optimize provider and team behavior Support patient selfmanagement Change the care system

22 Healthy lifestyle choices Disease self-management Prevention of diabetes complications Problem solving

23 Diabetes self-management education (DSME) Diabetes self-management support (DSMS) Nutrition therapy Physical activity Smoking cessation counseling Psychosocial care

24 provide knowledge and skill training help patients identify individual barriers facilitate problem solving and coping skills achieve effective self care behaviors and behavior change.

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26 AADE 7 Self-Care Behaviors

27 Emphasis on process and systems, rather than individuals Recognition of both internal and external customers Use of objective data to analyze and improve processes while measuring improvements

28 Optimize provider and team behavior Support patient self-management Change the care system

29 High-quality care must become an institutional priority Provide care using evidence based guidelines Expand the role of teams Track medication adherence

30 Redesign the care process Implement EHR tools Empower and educate patients Remove financial barriers Assess and address psychosocial issues Identify and engage the community

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32 Blood pressure less than 140/90 LDL cholesterol less than 100 mg/dl A1C less than 8% Being tobacco free Taking an aspirin daily, if appropriate

33 American Diabetes Association Standards of Medical Care In Diabetes AADE Continuous Quality Improvement for Diabetes Education and Support Programs. Measuring the Quality of Diabetes Care The American Journal of Managed Care March 2016, Volume 27, Special Issue 4

34 Betty Brackenridge, MS, RD, CDE

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