Iowa Healthcare Collaborative

Background

Diabetes is a complex, chronic illness and one of the leading causes of death and disability in the United States.  Diabetes affects 29.1 million Americans with 1.4 million new diagnoses each year.  Diabetes is a progressive disease that can lead to serious and long term complications, including heart disease, nerve damage, damage to other organ systems (kidneys, eyes, skin, etc.), when not adequately controlled.  Uncontrolled diabetes and the related complications can be deadly.  More than 300,000 people lost their lives in 2010 alone due to diabetes or a related complication.

The good news is that diabetes is a treatable and manageable condition.  Through the use of best practices, such as diabetes protocols, appropriate and effective medication therapies, referrals for self-management support, and care coordination with frequent follow-ups with patients, patients living with diabetes can achieve control, avoid unnecessary complications, and lead longer, healthier lives.

Goal

The Compass PTN aims to reduce percentage of patients with poor control of hemoglobin A1c (defined as A1c>9%) by 3% by 2019.

The "D5": Five Clinical Actions for Diabetes Care 

As a complex and progressive illness, diabetes is a chronic and potentially acute condition whose impact on a patient is whole-body and whole-person.  Because of this, there is compounding potential of diabetes to exacerbate other chronic conditions (i.e. hypertension), cause diabetes-related complications (diabetic retinopathy, neuropathy, etc.), and increase risks for potentially-life threatening health events, such as heart attack and stroke. 

To successfully treat and manage diabetes with patients, care must be encompassing.  Established clinical recommendations outline five leading actions that clinicians can take to support comprehensive diabetes management.  These five, basic standards are sometimes called the “ABCs, with E&F” or a “D5” of clinical diabetes care.  Detailed guidance, support, and recommendations for each of the D5 can be found in the Standards of Medical Care in Diabetes Care (PDF) (pages 48-56 and 75-98).

        A1c

               ● Control is defined as an A1c ≤7

               ● Check A1c at every 3 to 6 months

        Blood pressure

               ● Control is defined as 140/90 mmHg

               ● Check blood pressure at EVERY visit

        Cholesterol

               ● Target is set as triglycerides ≤150 mg/dL and/or low HDL (≤40 mg/dL [1.0 mmol/L] for men,
                    ≤50 mg/dL [1.3 mmol/L] for women)

               ● Check cholesterol every year

        Eye Exam

               ● Dilated eye exam every year

        Foot Exam

               ● Complete foot exam every year

Best Practice Guide

Standards of Diabetes Care (PDF) - American Diabetes Association (ADA)
A comprehensive guide to diabetes care and standards, developed by the multi-disciplinary Professional Practice Committee of the ADA, comprised of diabetes care practitioners and experts.  

 
Clinical Practice Guidelines for Developing a Comprehensive Care Plan (PDF) - American Association of Clinical Endocrinologists (AACE) And American College of Endocrinology (ECE)

A guidelines document from the AACE and ACE outlining best practices for development of comprehensive care plans, offering detailed step by step recommendations and targets for management interventions.   

 

Structuring Clinical Workflows for Diabetes Care (PDF) - University for Health Sciences, Medical Informatics, and Technology
A research article from Applied Clinical Informatics that outlines the process of designing a functional clinical workflow for diabetes care, inclusive of considerations for electronic health records (EHRs) and sample workflows.

 

Mapping and Redesigning Workflow (PDF) - Agency for Healthcare Research and Quality
A featured module of AHRQ's PCMH Primary Care Practice Facilitation Curriculum that offers detailed guidance in developing patient-centered care workflows for practices, featuring workflow maps, samples, and exercises/activities to support development.

 

 

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