A Population Health Management Diabetes Case Study
Session #27
A Population Health Management Diabetes Case Study
Rona Y. Sonabend, MD Medical Director, Clinical Systems Integration Process Improveme...
A Population Health Management Diabetes Case Study
Rona Y. Sonabend, MD Medical Director, Clinical Systems Integration Process Improvement Texas Children’s Hospital
Learning Objectives 1
2
3
4
5
Describe the population health model for pediatric diabetes care delivery at Texas Children's Hospital (Texas Children’s).
Illustrate disease management with the development of clinical programs.
Explain the use of data analytics to drive meaningful quality improvement.
Demonstrate the value of a maturity model in process improvement and associated outcomes.
Indicate lessons learned.
Poll Question #1 How would you rate the quality of care your organization delivers for patients with diabetes? 1) Poor 2) Fair 3) Good 4) Very good 5) Excellent 6) Unsure or not applicable
Texas Children’s vision statement for diabetes mellitus… We must… “Deliver the highest quality of care to patients with diabetes mellitus at Texas Children’s.”
About
208,000 children
diagnosed
The
with
and adolescents have been
diabetes, approximately 0.25% of the U.S. population.
number of children and adolescents
in the U.S. with type 1 diabetes is increasing.
The national was as high as
or type 2
burden of all diabetes mellitus
$245B
in 2012.
• • • • •
The Woodlands
Internationally renowned. Committed to creating a community of healthy children through excellence in patient care, education, and research. Three inpatient facilities in Houston and one in San Antonio. Multiple satellite ambulatory care centers. Manage more than 1 million patient encounters each year.
West Campus
Sugar Land
Clear Lake
Cy-Fair Main Campus
The Need to Reduce Variation and Improve Care •
Texas Children’s leaders noted a measurable degree of variation in its management of diabetes across the continuum of care.
•
This variation had been increasing over several years, leading to gaps in quality of care for diabetic patients.
•
Diabetes care met criteria for a focused improvement effort: • •
Large population of patients. High degree of variation in care.
• •
Measurable gaps in the consistency and quality of care. Organizational readiness.
Turning Point Texas Children’s recognized that incremental change would not suffice to transform diabetes care.
1.
2.
A comprehensive, cross continuum care improvement program for diabetes patients was necessary.
Mission Statements A Multidisciplinary, Cross-continuum Approach
Ambulatory
Create innovative diabetes outpatient program that provides coordinated, familycentered, multidisciplinary care to our patients and their families.
Eliminate unnecessary variations in inpatient care delivery and ease transition to outpatient care.
Inpatient
High Risk Diabetes CPTs
Develop diabetes and related health education for integration into diabetes care delivery.
Education
Community
Identify risks and barriers to optimal care and institute multidisciplinary processes to improve access to care and health outcomes in high-risk patients.
Build partnerships with care providers in the community by providing resources, education, and accessibility to provide comprehensive care for children with diabetes.
What Texas Children’s Did
Results
Improving Preventative Care Relative improvement in the percentage of patients receiving: recommended annual TSH testing.
recommended annual lipid testing.
recommended annual microalbumin testing.
annual retinal examinations.
28.2%
23%
37.9%
54.1%
50% 40% 30%
40% 30%
70% 80%
20%
0%
100%
Current performance at 90.4%.
60%
40% 30%
70% 80%
20%
90%
10%
50%
50%
50% 60%
100%
0%
Current performance at 90.3%.
40% 30%
70% 80%
20%
90%
10%
60%
0%
100%
Current performance at 91.8%.
70% 80%
20%
90%
10%
60%
90%
10%
100%
0%
Current performance at 94.9%.
Results
Impact of Risk-based Intervention
90%
100%
Patients with new onset diabetes who received a risk assessment at diagnosis.
Established patients with diabetes who have a predictive risk score for future hospitalizations.
30.9%
Relative reduction in recurrent diabetic ketoacidosis (DKA) admissions per fiscal year.
Results
Population Health Management
90%
Relative improvement in the percentage of patients with diabetes who received the influenza vaccine.
34.4% Relative improvement in pediatric provider knowledge, measured by pre- and post-tests, following completion of the pediatric provider diabetes education sessions.
26.3%
Percent of patients who have individualized school packets (orders for management of diabetes at school) available in the EHR.
