lf/p.richter,rn,q.a.dir. hedis 2011 comprehensive diabetic care rates patricia richter,rn, director...
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lf/P.Richter,RN,Q.A.Dir.
HEDIS 2011 Comprehensive
Diabetic Care RatesPatricia Richter,RN, Director Quality Improvement
lf/Patricia Richter,RN,Q.I.Dir.
CDC STRATEGY: PCP EMPOWERMENT
COLLABORATIVE PCP EDUCATION
PROGRAM
PERFORMANCE MEASURES
PROVIDER RELATIONS
lf/Patricia Richter,RN,Q.I.Dir.
lf/P.Richter,RN,Q.A.Dir.
139
160
Primary Care Physicians By County 2010
Reform 139 (Broward)Non-Reform 160 (DADE)
lf/Patricia Richter,RN,Q.I.Dir.
CDC COMPLIANCE MONITOR
FOCUSED MEDICAL RECORD REVIEWS
QUALITY IMPROVEMENT DM MRR TOOL CDC MEASURE REINFORCEMENT
lf/Patricia Richter,RN,Q.I.Dir.
Lf/.Richter,RN,Q.A.Dir.
Medical Record Audit Tool: Clinical Practice Guidelines Condition: Diabetes Patient: __________________________ DOB:______________ ID#: ______________ PCP: _______________Type of Diabetes (1 or 2):_____ Date of Onset:____________ Endocrinologist:_________________________Ophthomologist:__________________ Co-Morbid Conditions:___________________________________________________ Date of
Visit Date of Visit
Date of Visit
Date of Visit
Physical Findings Frequency History & Physical Comprehensive
1x annually
B/P < 130/80 Every Visit Height Annually Weight BMI < 27
Every Visit
Foot Check – sensation, pedal pulses, ulcer, color
Every Visit
Foot Exam- Comprehensive with monofilament
Annually (provide or refer)
Laboratory Tests A1c < 8 % Quarterly & every 6
months < 7.0
Urine microalbuminuria: < 20 ug/minn; screening
Annually
LDL < 100 mg/dl Annually HDL > 40 mg/dl Annually Triglycerides < 150 mg/dl Annually Diabetes Self-Management Review BG record Pre prandial 90-130 mg/dl Post prandial <180 mg/dl
Every Visit
Formal Self-Mgmt. Education Referral
Check Every Visit
Medical Nutrition Therapy Referral
Check Every Visit
Diet and Exercise Every Visit Preventative Care/Lifestyle Retinal or Dilated Eye Exam Referral
Annually
Daily admin, ASA Check Every Visit Influenza Vaccine Annually Pneumo Vaccine At least once Smoking Cessation Every Visit Dental Exam As Indicated Depression Screening As Indicated
Reviewer:______________________________________ Date:____________________
lf/Patricia Richter,RN,Q.I.Dir.
lf/P.Richter,RN,Q.A.Dir.
Health Maintenance Form Reporting Period: 01/01/2010 to 12/31/2010
Patient Name: ___________________________________________ DOB:_________________ ITEM MEASURE DATE SPEC 1. Flu vaccine Annual 2. Pneumonia vaccine One dose ages >65 yrs
3. Breast cancer screening Annual or prior year mammogram ages 40- 69 yrs female
4. Colorectal Ca screen Fecal Occult Blood Annual 50-75 yrs Flexible Sigmoidoscopy Every 5 years; 50-75 yrs Colonoscopy Every 10 years; 50-75 yrs 5. Osteoporosis screening Bone density female testing >65 yrs 6. Glaucoma screening Annual >65 years; no previous dx 7.A Diabetes care: Blood sugar controlled 18-75 yrs bi-annual HgB A1c <8 B Eye care retinal/dilated eye exam; annual
C Kidney monitoring <10 urine micro albumin; or medical attention for nephropathy; annual
D Cholesterol controlled Most recent annual level LDL-C <100
E Foot Care/Extremities Podiatry exam comp.with monofilament with Dx of diabetes: annual
F Weight/BMI >28 Diet/ formal Self-Mgmt Ed. Nutritionist. 8. Controlling blood pressure 18-85 yrs bp <140/90 dx hypertension
9. Confirm COPD by Spirometry >40 yrs with a diagnosis COPD; new diagnosis and/or exacerbation(s)
10. Rheumatoid arthritis mgmt
>18 yrs DMARD Rx (disease modifying anti- rheumatic drug) with a diagnosis of rheumatoid arthritis.
11. Bladder control management
>65 yrs reported having a urine leakage problem in the past 6 months and received treatment. Code 788.30
12. Long term meds management
>18 yrs K, Creatinine, BUN:ACE/ARB's, digoxin, diuretics, anticonvulsants- serum level
13. Ischemic vascular disease Annual LDL-C
14. Fall risk management >65yrs discussion regarding balance/walking/falls
15. Maintain mental health Assess member’s emotional health. depression, loss of interest, etc.
16. Monitor physical activity Annual physical address start, increase, maintain level exercise, activity
lf/Patricia Richter,RN,Q.I.Dir.
A1c T
est
A1c >
9
A1c <
8
Eye E
xam
LDL Scr
een
LDL <10
0
Nep
hrop
athy
0
40
80
120
GoalCompliance
HEDIS 2011 Comprehensive Diabetic Care RatesNon-Reform – Hybrid Record Review
Population 171 Goal MeasureA1c Test 85.6% 98.2%A1c >9 46.7% 39.2%A1c <8 38.9% 58.5%Eye Exam 62.5% 75.4%LDL Screen 78.6% 95.3%LDL <100 37.9% 43.9%Nephropathy 80.5% 93%
lf/Patricia Richter,RN,Q.I.Dir.
A1c T
est
A1c >
9
A1c <
8
Eye E
xam
LDL Scr
een
LDL <10
0
Nep
hrop
athy
0
40
80
120
GoalCompliance
HEDIS 2011 Comprehensive Diabetic Care RatesReform – Hybrid Record Review
Population 338 Goal MeasureA1c Test 85.6% 98.2%A1c >9 46.7% 35.5%A1c <8 38.9% 59.5%Eye Exam 62.5% 68%LDL Screen 78.6% 91.7%LDL <100 37.9% 47%Nephropathy 80.5% 94.7%
lf/Patricia Richter,RN,Q.I.Dir.
lf/P.Richter,RN,Q.A.Dir.
Thank you and have a
Quality Year!
lf/Patricia Richter,RN,Q.I.Dir.