Managing Diabetes for Improved Cardiovascular Health Jimmi Norris MS, RN, CDE An Important Reminder For audio, you must use your phone: Step 1: Call (866) 906 0123. Step 2: Enter code 2071585#. Step 3: Mute your phone!!! = AUDIO Mission of OFMQ OFMQ is a not for profit, consulting company dedicated to advancing healthcare quality. Since 1972, we ve been a trusted resource through collaborative partnerships and hands on support to healthcare communities. 1
OFMQ Service Lines Analytics Case Review Education IT Consulting Health Information Technology National Quality Measures Quality Improvement Additional HIT Service Lines Security Risk Assessment Level 1, 2, and 3 Meaningful Use Assistance Meaningful Use Audit Support Risk Management Consulting and Development Staff IT Security Training Website Development & Secure Email IT Consulting Jimmi Norris MS, RN, CDE Jimmi Norris is an HIT Practice Advisor at OFMQ. She has 25+ years healthcare experience working in hospital and ambulatory settings focusing on cardiac care and diabetes education. Her most recent experience has been working with providers and staff to improve clinical workflows and clinical documentation in ambulatory practices and hospitals. Other initiatives include staff education related to meaningful use and clinical quality measures. 2
OFMQ & OSDH Grant Initiative Partnership to engage health care providers to participate in the Million Hearts initiative National initiative launched in 2012 by the U.S. Department of Health and Human Services that is co led by CDC and CMS Goal Prevent 1 Million Heart Attacks and Strokes by 2017 Objectives Diabetes overview Review prevalence of diabetes in the US & Oklahoma Discuss the impact of diabetes on cardiovascular health Review best practices & clinical guidelines for management of diabetes for improved cardiovascular health Review HIT strategies to better manage diabetes Diabetes Overview Diabetes is a group of diseases characterized by high blood sugar. When a person has diabetes, the body either does not make enough insulin or is unable to use its own insulin well. Source: Centers for Disease Control and Prevention. Diabetes Report Card 2014. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2015 3
Types of Diabetes Type 1 diabetes (sudden onset) Little or no insulin is being produced (beta cell destruction) Used to be known as juvenile diabetes, Insulin Dependent Diabetes Mellitus (IDDM) Accounts for about 5% of all diagnosed diabetes in US adults Type 2 diabetes (progressive onset) Usually begins as insulin resistance & eventually decreased beta cell function Associated with aging, obesity, family history, inactivity, race and ethnicity Accounts for about 90% 95% of all diagnosed diabetes in US adults Gestational diabetes Occurs during pregnancy & increases risk for type 2 diabetes later in life Prediabetes Higher than normal blood sugar levels & increases risk for type 2 Source: Centers for Disease Control and Prevention. Diabetes Report Card 2014. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2015 Diagnosed Adult Diabetes Rates in US 2013 6.7% 6.8% 6.3% 10.2% 10.9% 12.7% 13.7% http://www.cdc.gov/diabetes/atlas/obesityrisk/atlas.html Diagnosed Adult Diabetes Rates in OK 2013 7.9% 10.1% 10.1% 13.1% 13.5% http://www.cdc.gov/diabetes/atlas/obesityrisk/atlas.html 4
Key Facts of Diabetes High blood sugar has a direct impact on all body organs Complications include High Blood pressure High cholesterol Cardiovascular disease Stroke (1.5 times higher in diabetes) Heart attacks (1.8 times higher in diabetes) Blindness Kidney disease Amputation People with diagnosed diabetes have health care costs 2.3 times higher than people without diabetes Source: http://www.diabetes.org/diabetes basics/statistics/ American Diabetes Association Guidelines to Diagnose Diabetes A1C 6.5% (hba1c or glycated hemoglobin) Fasting plasma glucose (FPG) 126 mg/dl OR OR 2-h plasma glucose 200 mg/dl during an OGTT OR A random plasma glucose 200 mg/dl Prediabetes A1C 5.7-6.4% Source: ADA. 2. Classification and Diagnosis. Diabetes Care 2015;38(suppl 1):S9; Table 2.1 Recommendations for Glycemic Control in Adults with Diabetes < 7% Diabetes Control & Complications Trial DCCT study started in 1982 suggested that Lowering A1C to below or around 7% has been shown to reduce microvascular complications ( eye, kidney & nerve) and, if implemented soon after the diagnosis of diabetes, is associated with long term reduction in macrovascular disease (stroke and heart attacks). Therefore, a reasonable A1C goal for many nonpregnant adults is <7% Source: ADA 6. Glycemic Targets. Diabetes Care 2015;38(suppl 1):S35 5
ADA Recommended Guidelines for Diabetes Care Test/exams/therapies Goals A1C at least twice a year BP at each visit Cholesterol (HDL, LDL, Triglycerides Diabetes eye exam Diabetic Foot exam Quantitative urine protein & GFR Aspirin therapy Immunizations Flu Weight and tobacco screening < 7% < 140/90 HDL >40 men: >50 women: LDL <100 known CVD: Triglycerides <150 Comprehensive at least yearly Comprehensive at least yearly At least yearly: < 30mg/g creatinine Based on presence of CVD Yearly Weight reduction & tobacco cessation Source: ADA Standards of Medical Care in Diabetes 2015 Identify Uncontrolled Diabetes Query NQF 59 (CMS 122) to identify patients with poor controlled A1C Targets the percentage of patients 18 75 years with diabetes (type 1 or type 2) who had HbA1c > 9% during the measurement period In EHR report is located Reports Quality or Clinical Quality Measures Meaningful use Registry Inverse measure lower scores indicate higher quality Example 9 out of 10 patients had A1C 10 or above, performance rate is 90% Numerator calculations are based on the patients with diabetes that had an A1c >9 Example 10 patients, none had A1c results, performance rate is 0% 6
Identify Care Opportunities by Using HIT Tools are located in the patient s chart to identify gaps in care Diabetes dashboard Diabetes flowsheet Health Maintenance dashboard Care Opportunities dashboard Actionable in some EHRs Can be customized in most EHRs For Continuous Improvements Re Evaluate NQF 59 Measure at least quarterly Compare data Individual level reports Clinic level reports Benchmark reports Utilize Your EHR to Optimize the Management of Diabetes A1c results are flowing into a reportable field Set A1C alert parameters to highlight in red on the flowsheet Set health maintenance rules to alert when next A1C is due Utilize the clinical decision support to embed clinical guidelines and best practices for diabetes at the point of care Tools to detect overdue care opportunities Implement treatment protocols or orders sets at the point of care Utilize the patient portal to engage patients to self monitor and report blood glucose readings readings Use CPOE to order and track referrals for diabetes management Use patient reminder system to track patients for follow up Measure NQF 59 at least quarterly for improvements Use unmet patient report as a patient recall list for follow up 7
We Are Here To Help! Email: ofmqhit@ofmq.com Call: (877) 963 6744 Visit: www.ofmq.com Questions? ICD 10 Training in OKC & Tulsa Our workshop provides assistance from AHIMA approved ICD 10 CM trainers to help you learn how to successfully transition from ICD 9 to ICD 10 coding. OKC, August 20 Tulsa, August 26 Choose a date & register at www.ofmq.com/events month Upcoming WebEx Seminars Wed, August 22 12:15pm (Central Time) e Clinical Quality Measures for Providers & Hospitals Wed, September 23 12:15pm (Central Time) Meaningful Use Audits for Medicare & Medicaid Register at www.ofmq.com/event month 8
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