Performance Performance Improvement: Improvement: Continuing - PowerPoint PPT Presentation

Performance Performance Improvement: Improvement: Continuing Continuing Medical Education Medical Education Lara Zisblatt, MA Lara Zisblatt, MA Assistant Director Assistant Director Boston University Boston University School of Medicine School of Medicine Continuing Medical Education Continuing Medical Education

Welcome! Welcome! MENTOR QI™ ™ Diabetes Performance Diabetes Performance MENTOR QI Improvement Initiative, Getting Patients Improvement Initiative, Getting Patients to Goal in Glycemic Glycemic Control Control to Goal in � To register: To register: www.mentorqi.com www.mentorqi.com � � To preview the site, please go to: To preview the site, please go to: � http://www.mentorqi.com www.mentorqi.com/Apps/ /Apps/ http:// System/Logon.aspx Logon.aspx System/ – User name: diabetes User name: diabetes – – Password: diabetes Password: diabetes –

Performance Improvement CME Performance Improvement CME � Performance Improvement: 20 Performance Improvement: 20 AMA � AMA ™ PRA Category 1 Credits ™ PRA Category 1 Credits � Teleconferences: 1 Teleconferences: 1 AMA PRA Category � AMA PRA Category ™ for each teleconference, total for each teleconference, total 1 Credit ™ 1 Credit of 6 teleconferences of 6 teleconferences Total of 26 AMA PRA Category 1 Credits ™ Total of 26 AMA PRA Category 1 Credits ™

MENTORQI.com Steps Steps MENTORQI.com On left side bar, click on: On left side bar, click on: 2. Practice Assessment 2. Practice Assessment – Survey of 23 questions to get a snapshot of Survey of 23 questions to get a snapshot of – your practice your practice 3. My Patient Chart Review (Baseline) 3. My Patient Chart Review (Baseline) – Complete 10 chart reviews of patients with a Complete 10 chart reviews of patients with a – diagnosis of type 2 diabetes diagnosis of type 2 diabetes 4. Assess My Performance 4. Assess My Performance – Review a feedback report of your baseline data, Review a feedback report of your baseline data, – your peers’ ’ data, and national benchmarks data, and national benchmarks your peers

MENTORQI.com Steps Steps MENTORQI.com On left side bar click on: On left side bar click on: 5. Build Action Plan 5. Build Action Plan – Choose from a menu of intervention options that include Choose from a menu of intervention options that include – building a patient registry or creating a patient reminder building a patient registry or creating a patient reminder system for A1C testing system for A1C testing – Implement your Action Plan and wait 3 months before Implement your Action Plan and wait 3 months before – reassessment reassessment 6 & 7. Chart Review and Practice Assessment 6 & 7. Chart Review and Practice Assessment (Follow- -up) up) (Follow – After the 3 After the 3- -month waiting period, you will be invited back to month waiting period, you will be invited back to – the site to complete your follow- -up practice assessment and up practice assessment and the site to complete your follow chart review chart review – After completing the follow After completing the follow- -up activities, you will receive up activities, you will receive – your certificate for 20 AMA PRA Category 1 Credits ™. . your certificate for 20 AMA PRA Category 1 Credits ™

Maintenance of Certification Maintenance of Certification � Approved by the American Board of Approved by the American Board of � Family Medicine (ABFM) for Part IV Family Medicine (ABFM) for Part IV Credit required for Maintenance of Credit required for Maintenance of Certification for Family Physicians Certification for Family Physicians � If you are interested in Part IV credit, If you are interested in Part IV credit, � please e- -mail BUSM CME at mail BUSM CME at please e mentorqi@bu.edu or call us at or call us at mentorqi@bu.edu 800.688.2475 800.688.2475

Participants Participants PROFESSION TOTAL PROFESSION TOTAL NURSE PRACTITIONER 41 NURSE PRACTITIONER 41 NUTRITIONIST/DIETITIAN 2 NUTRITIONIST/DIETITIAN 2 PHARMACIST 2 PHARMACIST 2 PHYSICIAN 14 PHYSICIAN 14 PHYSICIAN ASSISTANT 17 PHYSICIAN ASSISTANT 17 REGISTERED NURSE 2 REGISTERED NURSE 2 STUDENT 2 STUDENT 2 GRAND TOTAL 80 GRAND TOTAL 80

Thank You! Thank You! � Please complete chart reviews as soon Please complete chart reviews as soon � as possible as possible � If you are having trouble completing If you are having trouble completing � the chart reviews, please let us know. the chart reviews, please let us know. We can help! We can help! � If you have any questions, please If you have any questions, please � e- -mail us at mail us at mentorqi@bu.edu mentorqi@bu.edu or call or call e us at 800.688.2475 us at 800.688.2475

Type 2 Diabetes Performance Type 2 Diabetes Performance Improvement Program: Improvement Program: Clinical Overview Clinical Overview Elliot Sternthal, MD, FACP Elliot Sternthal, MD, FACP Clinical Director of Clinical Director of Diabetes Services Diabetes Services Boston Medical Center Boston Medical Center Boston, MA Boston, MA

Overview of Diagnosed and Undiagnosed Overview of Diagnosed and Undiagnosed Diabetes in the United States— —2008 2008 Diabetes in the United States People With Diabetes: 24 million People With Diabetes: 24 million (8.0% of the population) (8.0% of the population) People Without Diagnosed: People Without Diagnosed: Diabetes 18 million Diabetes 18 million Undiagnosed: Undiagnosed: 6 million 6 million � Incidence: 1.5 million new cases diagnosed yearly Incidence: 1.5 million new cases diagnosed yearly � � Number of adult patients predicted to grow to ~22 million by 20 Number of adult patients predicted to grow to ~22 million by 2025 25 � � Vast majority (>90%) of cases are type 2 diabetes � Vast majority (>90%) of cases are type 2 diabetes Adapted from American Diabetes Association. Available at: http:// http://www.diabetes.org www.diabetes.org. Accessed . Accessed Adapted from American Diabetes Association. Available at: June 25, 2008. 2008. June 25,

The Dual Epidemic: The Dual Epidemic: Obesity and Diabetes Obesity and Diabetes � 65% of US adults are overweight (BMI >25) and 65% of US adults are overweight (BMI >25) and � 30% are obese (BMI >30) 30% are obese (BMI >30) � 24% have the Metabolic Syndrome 24% have the Metabolic Syndrome � � There are now an estimated 24 million people There are now an estimated 24 million people � with diabetes mellitus (DM) in the US; 57 million with diabetes mellitus (DM) in the US; 57 million have pre- -diabetes diabetes have pre � The lifetime risk of developing DM for people The lifetime risk of developing DM for people � born in 2000 is 33% for men and 39% for women born in 2000 is 33% for men and 39% for women – For Hispanic women, the lifetime risk is 50% For Hispanic women, the lifetime risk is 50% – � In this population, cardiovascular disease (CVD) In this population, cardiovascular disease (CVD) � is the major cause of mortality is the major cause of mortality

Obesity Trends* Among US Adults Obesity Trends* Among US Adults *BMI ≥ ≥ 30. 30. *BMI Adapted from Centers for Disease Control and Prevention. Adapted from Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance Behavioral Risk Factor Surveillance . Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm. . System . Available at: http:// System Accessed June 20, 2008. Accessed June 20, 2008.

Role of Obesity in Metabolic Role of Obesity in Metabolic Syndrome (MS) Syndrome (MS) � NHANES III Population NHANES III Population � – Normal weight Normal weight – – 5% had MS 5% had MS – – Overweight Overweight – – 22% had MS 22% had MS – – Obese Obese – – 60% had MS 60% had MS – � Framingham Population Framingham Population � – Obese w/o MS Obese w/o MS – – no significant no significant � � risk of DM2 or risk of DM2 or – CVD CVD – Obese with MS Obese with MS – – 10 x 10 x � � risk DM2, 2 x risk DM2, 2 x � � risk CVD risk CVD – – Normal weight with MS Normal weight with MS – – 4 x 4 x � � risk DM2, 3 x risk DM2, 3 x � � – risk CVD risk CVD

Metabolic Syndrome and Metabolic Syndrome and Type 2 Diabetes Type 2 Diabetes � Botnia Botnia Study (large, high Study (large, high- -risk family study in risk family study in � Finland & Sweden) Finland & Sweden) – 84% men & 78% women with DM2 had MS 84% men & 78% women with DM2 had MS – – 64% men & 42% women with pre – 64% men & 42% women with pre- -DM had MS DM had MS – 15% men & 10% women with normal glucose tolerance 15% men & 10% women with normal glucose tolerance – had MS had MS � Prospective Observational Studies Prospective Observational Studies � – Non Non- -diabetic Pima Indians with MS: 2.1 diabetic Pima Indians with MS: 2.1- -3.6 x 3.6 x � � risk risk – DM2 DM2 – Caucasians with MS: 7 Caucasians with MS: 7- -34 x 34 x � � risk DM2 risk DM2 – � MS components without impaired fasting MS components without impaired fasting � glucose still at � � risk of DM2 risk of DM2 glucose still at Isomaa B, et al. B, et al. Diabetes Care . 2001;24:683- -689. 689. Isomaa Diabetes Care . 2001;24:683