IHS Diabetes Audit Karen Sheff, MS IHS Division of Diabetes - PowerPoint PPT Presentation

Tribal Leaders Diabetes Committee Meeting Washington, DC IHS Diabetes Audit Karen Sheff, MS IHS Division of Diabetes Treatment and Prevention March 20, 2019

Today’s Audit Topics 1. Introduction 2. History 3. Reports 4. Outcomes 5. Questions

Audit History 1980’s: First Audits (local) • 1997: Nationwide participation • 1998-2020: Requirement for SDPI grantees • In 2018: • All 12 Areas, including IHS, tribal, and urban facilities o 323 facilities o >123,00 patients o 44+ outcomes o

Audit Introduction

What is the Audit and why do it? What: A process for assessing diabetes care and health outcomes for American Indian and Alaska Native people with diagnosed diabetes. Why: 1. Work towards the goal of providing all diabetes patients with the highest quality of care, as outlined in the IHS Diabetes Standards of Care 2. Assess the diabetes care provided at a facility, including strengths and areas for improvement 3. Fulfill requirements of Special Diabetes Program for Indians (SDPI) grants (participation in Annual Audit) 4. Contribute to Area and IHS outcome measures and reports

Diabetes Standards of Care & Clinical Practice Resources https://www.ihs.gov/diabetes/clinician-resources/soc/

Who conducts Audit? IHS/Tribal/Urban health care facilities • Participation in the Annual Audit is required for SDPI grantees. • Others are welcome and encouraged to participate in the Annual Audit. • All participating facilities have access to all Audit resources, regardless of whether they have an SDPI grant.

How are Audits conducted? 1. Health care facilities gather data for their patients with by one of two methods: a. Electronic Audit: Data are extracted from an electronic medical record system into a data file. b. Manual Audit: Paper charts are reviewed and data are written onto a paper Audit form for each patient. 2. Facilities submit this data to DDTP via a system called the WebAudit.

What does DDTP do with data from the facilities? 1. Reviews for potential errors and corrects as many as possible. 2. Provides reports to each participating facility: a. Current year b. Trends over time 3. Analyzes data across facilities to prepare reports for: a. Each Area b. All Areas combined 4. Reports results to: a. Stakeholders (including Tribal leaders) b. Others: SDPI Reports to Congress, government and other publications

What about facilities that don’t use RPMS? • Two options: – Program software to extract Audit data from their EHR – Conduct a manual Audit • Extra resources provided by DDTP: – Training webinar specific to these sites – Early access to Audit materials for the coming year

Audit Reports

Main Audit Report • Provides results for all data items for one year. • For 2018: – 6 pages – 25 sections – 160 outcomes • PDF format for easy printing and distribution.

Audit Report for 2018 Sample section from page 1 of 6 586 charts were audited from 586 patients on the diabetes registry.

Trends Graphs Example

Trends Graphs • Each graph shows results over time from 2008- 2018. • 18 graphs with results for dozens of outcomes. • Excel format – Can easily be copied and pasted into documents and presentations. – Can be edited, as needed. – Additional graphs can be created from data in file.

Audit Outcomes

What outcomes does the Audit measure? • Blood pressure • Height and weight • Tobacco use • Exams • Education • Medications • Immunizations • Lab results • Comorbidities: depression, CVD, TB • More … There are changes every year!

Number of Participating Facilities 1997-2018 360 320 280 240 # of Facilities 200 160 120 80 40 0 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Audit Year Source: IHS Diabetes Care and Outcomes Audit

Number of Charts Audited 1997-2018 130 120 110 Number of Charts (1000's) 100 90 80 70 60 50 40 30 20 10 0 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Audit Year Source: IHS Diabetes Care and Outcomes Audit

Mean A1C 1997-2018 10.0 9.5 9.0 Mean A1C (%) 8.5 8.0 7.5 7.0 6.5 6.0 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Audit Year Source: IHS Diabetes Care and Outcomes Audit

Mean Blood Pressure 1997-2018 160 150 140 Systolic Mean BP (mmHG) 130 120 110 100 90 Diastolic 80 70 60 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Audit Year Source: IHS Diabetes Care and Outcomes Audit

Mean LDL Cholesterol 1998-2018 150 Mean LDL Cholesterol (mg/dl) 140 130 120 110 100 90 80 70 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Audit Year Source: IHS Diabetes Care and Outcomes Audit

Education 1997-2018 100 90 80 70 % Patients 60 50 40 30 20 DM Nutrition Physical Activity Any DM Education 10 0 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 9 9 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 9 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Audit Year Source: IHS Diabetes Care and Outcomes Audit

CKD Stage Excluding Unknown (Age ≥18) 2009-2018 100 Normal Stage1 or 2 Stage3 Stage4 Stage5 Normal : eGFR=>60 & UACR<30 90 Stage 1 & 2 : eGFR=>60 & UACR=>30 Stage 3 : eGFR 30-59 Stage 4: eGFR 15-29 80 Stage 5: eGFR <15 70 % Patients 60 50 40 30 20 10 0 9 0 1 2 3 4 5 6 7 8 0 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 Audit Year Source: IHS Diabetes Care and Outcomes Audit

Diagnosed CVD and Antiplatelet and Statin Medication 2013-2018 100 90 Of patients with CVD dx, antiplatelet therapy prescribed 80 70 Of patients with CVD dx, 60 % Patients statin prescribed 50 40 CVD dx 30 20 10 0 3 4 5 6 7 8 1 1 1 1 1 1 0 0 0 0 0 0 2 2 2 2 2 2 Audit Year Source: IHS Diabetes Care and Outcomes Audit

Audit Website https://www.ihs.gov/diabetes/audit

Commonly Used Abbreviations • ADC = Area Diabetes Consultant • Audit = IHS Diabetes Care and Outcomes Audit • DDTP = IHS Division of Diabetes Treatment and Prevention • DMS = RPMS Diabetes Management System • EHR = Electronic Health Record (System) • GPRA = Government Performance and Results Act • I/T/U = IHS/Tribal/urban • PHI = Protected Health Information • PII = Personally Identifying Information • RKM = Required Key Measure • RPMS = Resource and Patient Management System • SDPI = Special Diabetes Program for Indians • SOS = SDPI Outcomes System

Questions?

Thank You!