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Page 1: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

November 14, 2019

Page 3: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts
Page 4: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Connects North Carolinians with prediabetes to a

Diabetes Prevention Program (DPP).

Page 5: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Provider/ patient makes a referral.

DPP Navigator contacts referred patient.

DPP Navigator verifies patient eligibility.

Patient is

enrolled in DPP.

Provider receives patient status updates.

Step 1

Step 2

Step 3

Step 4DiabetesFreeNC Process

Page 6: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Connects North Carolinians with prediabetes to a

Diabetes Prevention Program (DPP).

Page 8: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Provider/ patient makes a referral.

DPP Navigator contacts referred patient.

DPP Navigator verifies patient eligibility.

Patient is

enrolled in DPP.

Provider receives patient status updates.

Step 1

Step 2

Step 3

Step 4DiabetesFreeNC Process

Page 9: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Provider makes a patient referral.

866-366-2329

[email protected]

NCCARE360.org

or

Page 10: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Step 1: DPP Navigator contacts referred patient.

Page 11: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Step 2: DPP Navigator verifies patient eligibility.

Page 12: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Must score five or higher on the risk test.

Step 2: DPP Navigator verifies patient eligibility.

Page 13: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Step 3: Patient is enrolled in a DPP.

Page 14: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

DPP Navigator reports

enrollment and completion

status to the referring provider.

Step 4: Referring provider receives patient updates.

866-366-2329

[email protected]

NCCARE360.org

or

Page 15: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Real-time, live interaction with a DPP Navigator

Eliminate the barrier of searching for a DPP

Established relationships with DPP lifestyle coaches

Bidirectional feedback for providers

DPP Navigator Benefits

Page 16: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts
Page 17: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Every referral may

prevent a future diabetes

diagnosis.

Page 18: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts
Page 19: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts
Page 20: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Purpose: strengthen Stroke System of Care and guide Stroke Advisory Council work

Goals:

1. Guide efforts to increase access to care

2. Increase quality, coordinated care

3. Enhance post-stroke care

4. Prevent strokes

5. Advocate for stroke prevention and care

Primary audience: providers of stroke care

Format: web-based with full annual review and on-going review of additions and revisions

Page 21: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Strategies and Resources in Four Sections

I. Stroke Prevention

II. Stroke Care

III. Post-Stroke Care

IV. Advocacy

Action Plan

Page 22: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

#1 Clinical Practice Guidelines = Why we do it

#2 Tools for application = How we do it

Standardization of work flows

Communication between EMS and hospital

Recommendation for prehospital stroke assessment

Collaboration with primary care providers

Diagnostic imaging

Stroke data

Stroke Registry

Page 23: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

Review and provide feedback by January 10, 2020

SAC Meeting February 26, 2020

Page 24: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

startwithyourheart.com

Page 25: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts
Page 26: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

• Inventory all telestroke services available in NC

• Update telestroke map

• Partner with NCHA, OEMS, etc. to keep list of telestroke sites current

• Identify gap areas

• Assess need for development of telestroke system

Page 27: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

• EMS transport of stroke patients

• Prehospital stroke assessment

• Selection of appropriate transport method

• Selection of appropriate hospital as transport destination

• Assessment of disparities in EMS access

• Prehospital documentation and metrics

• Documentation of baseline deficits and communication of deficits as patients move through continuum of care

Page 28: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

• Case data abstraction guidelines

• Hospital capacity to abstract data

Page 29: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts

• Purpose

• Objectives

• Measures across the care continuum

• Collaboration with NC HealthConnex

Page 30: November 14, 2019 · November 14, 2019. Connects North Carolinians with prediabetes to a Diabetes Prevention Program (DPP). Provider/ patient makes a referral. DPP Navigator contacts