How Could UW Health Provide the Best Diabetes Care in Wisconsin?

Sue PelatzkeMichael Barbouche

Lawrence Fleming, M.D.

June 15, 2005

Presentation Objectives

1. Introduce the Wisconsin Collaborative for Healthcare Quality (WCHQ).

2. Review UW Health’s performance in diabetes care.

3. Discuss how, within UW Health, we could improve diabetes care.

About WCHQ?

• The Wisconsin Collaborative for Healthcare Quality was founded in 2002

• Participation of health care systems, physician groups, hospitals, employer/consumer groups is voluntary

• Collaboration on improving healthcare in Wisconsin by developing a set of outcome measures of quality

• Public reporting of performance of participating healthcare organizations

WCHQ Growth

• 2002 – 6 health systems in non-competing markets

• 2004 – 12 health systems statewide– 11 Hospitals– 12 Physician Groups– 5 Employers/Consumer Groups– Independent Auditor – MetaStar

Present WCHQ Member Organizations

• Advanced Healthcare, S.C.• Affinity Medical Group• Aspirus, Wausau Hospital• Belin Health• Columbia St. Mary’s• Dean Health System• Franciscan Skemp Healthcare• Froedert and Community Health• Gundersen Lutheran• Luther Midelfort• Marshfield Clinic• Medical Associates Health Center• Medical College of Wisconsin• Meriter Hospital and Physicians Plus Insurance

Present WCHQ Member Organizations

• Prevea Health Services• Sacred Heart Hospital• Saint Joseph’s Hospital• St. Mary’s Hospital Medical Center• ThedaCare• UW Hospital and Clinics• UW Medical Foundation

WCHQ Member Organizations Agree To:

• Share comparative quality performance data among members for the purpose of improving performance

• Independent third-party audit and data validation• Publicly report comparative quality performance

data

WCHQ Measures

The “Six IOM Aims” for improving the quality of healthcare:– Safety– Timeliness– Effectiveness– Efficiency– Equity– Patient-Centeredness

WCHQ Measures

The Clinical Topics– Access– Critical Care– Diabetes– Health Information Technology– Heart Care– Patient Satisfaction– Pneumonia– Surgery– Women’s Health

Value of Public Reporting

• There is little evidence that public reporting will change consumer choice of health care providers, or will improve quality

HOWEVER,• UWMF’s and UWHC’s participation has provided

the stimulus to measure quality across the UW Health system and will direct and quantify subsequent improvement

The Process, with Diabetes Care as an Example

1. Defining the measures

2. Finding the data

The Diabetes Care Measures

1. Blood sugar (A1c) testing within the last 12 months

2. LDL cholesterol testing within the last 12 months

3. Kidney function monitored within the last 12 months

4. Blood sugar (A1c) control

5. LDL cholesterol control

Collecting the Data for the Five Diabetes Measures

NumeratorsObtained from administrative data (billing)

OrSpecific Lab/Clinical Values

__________________________

Denominator

Identifies current/active patients with diabetes and is obtained from administrative data

Building the Denominator

Data Warehouse

All Office Visits in 24 Months

Out

No

Yes

Out

No

Yes

Out No

Yes

DENOMINATOR

FINAL October 5, 2004

Question 2:Is this a Patient we manage?

Question 3:Is this a Patient that iscurrent in our system?

Question 1:Is this a Patient with Diabetes?

Yes

Out

No

KEY24 Months = Measurement Year + Prior Year12 Months = Measurement YearDiabetes Dx = ICD-9-CM Codes from Table D-1Office Visit = CPT Codes from Table D-2PCP = Pediatrics, Internal Medicine, Family Practice (MD, DO, PA, NP)Primary Care Office Visit = Office Visit in a Non-Urgent Care setting

WCHQ Ambulatory Care Measures - Diabetes DenominatorEndocrinologist considered SPECIALIST

Patient has atleast two Office Visits w/

Diabetes Dx(Any Provider)

At least onePrimary Care Office

Visit w/ PCPin 24 Months

(Any Dx)

At least twoPrimary Care OfficeVisits w/ PCP and/or

Endocrinologistin 24 Months

(Any Dx)

At least one Primary Care OfficeVisit w/ PCP and/or

Endocrinologistin last 12 Months

(Any Dx)

Finding UW Health Lab Data – Eliminate Black Holes and Dead Ends

UWMF Clinics20 S. Park

UCC

EPIC

EPIC WEB

Beaver Dam

All Other UCC

Research Park

CSC Lab

Rough Layout of UW Health Lab Flow/DataUW Health/WCHQ Project

DRAFT

DFM

Verona“50/50”

Beaver Dam Community

Hospital

St. Marys

Quest

GML

All OtherDFM

“70%”

“70%”

“30%”

“30%”

“UNDERCONSTRUCTION”

LIS = MISYS

UW Hospital

UWHC Clinics

University Health Service

LIS = McKesson Horizon Lab

WISCR

WISCR

LIS = ALG

Note: Not allUWHC Clinic

Data isReported

NOT in WISCR

October 18, 2004

Primary role as backup;nights/weekends; tissues

KEYElectronic Flow “within” UW HealthExternal Flow “outside” UW Health

How are Data Collected, Reported?

• 2005• -April, 2005, the first public reporting of the performance

data for participating entities.• -UW submitted one number for each measure for all of

UW Health. So, the one number reflects performance across all UW Health Clinics and for 5,298 patients with diabetes (5,298 is the denominator).

• 2006 and beyond-Public reporting may be more focused to the clinic level or even individual physician level.

UW Health’s Performance in Screening Measures for Patients with Diabetes for

7/1/03-6/30/04• A1c screening (4,944 / 5,298) = 93.3%• LDL screening (3,742 / 5,298) = 70.6%• Nephropathy screening (3,960 / 5,298) = 74.5%

74.5%

70.6%

93.8%

0% 20% 40% 60% 80% 100%

UW HealthDiabetes Screening Rates

A1c

LDL

Nephropathy

Glycemic Control Measure

“Optimal”- A1c < 7% “Near optimal”- A1c 7% to 9% “Poor control”- A1c > 9% “Not tested”

LDL Control Measure for Patients with Diabetes

“Optimal”- LDL < 100 mg/dL “Near optimal”- LDL 100-130 mg/dL “Poor control”- LDL > 130 mg/dL “Not tested”

41.53%

45.85%

19.29%

37.20%

29.36%9.82%

10.27% 6.68%

0% 20% 40% 60% 80% 100%

LDL

A1c

Optimal Near Optimal Poor Not Tested

UW HealthDiabetes Control

0% 20% 40% 60% 80% 100%

20 S. Park 405 (n=554)

20 S. Park 504 (n=669)

East (n=208)

East Towne (n=380)

University Station (n=389)

West A/B (n=310)

West C/D (n=325)

Women's Health (n=182)

West Towne (n=335)

UW Health (n=5298)

A1c LDL

Diabetes Screening RatesUW Health Internal Medicine Clinics

0% 20% 40% 60% 80% 100%

20 S. Park 405 (n=554)

20 S. Park 504 (n=669)

East (n=208)

East Towne (n=380)

University Station (n=389)

West A/B (n=310)

West C/D (n=325)

Women's Health (n=182)

West Towne (n=335)

UW Health (n=5298)

A1c LDL Nephropathy

Diabetes Screening RatesUW Health Internal Medicine Clinics

0% 20% 40% 60% 80% 100%

20 S. Park 405 (n=554)

20 S. Park 504 (n=669)

East (n=208)

East Towne (n=380)

University Station (n=389)

West A/B (n=310)

West C/D (n=325)

Women's Health (n=182)

West Towne (n=335)

UW Health (n=5298)

Optimal Near Optimal Poor Not tested

Diabetes A1c ControlUW Health Internal Medicine Clinics

0% 20% 40% 60% 80% 100%

20 S. Park (n=554)

20 S. Park (n=669)

East (n=208)

East Towne (n=308)

University Station (n=389)

West A/B (n=310)

West C/D (n=325)

Women's Health (n=182)

West Towne (n=335)

UW Health (n=5298)

Optimal Near Optimal Poor Not tested

Diabetes LDL ControlUW Health Internal Medicine Clinics

How Might We Improve Glycemic Control in Our Patients with Diabetes?

Improvement will require the talents and energy of an entire clinic staff.

Improvement will come only if it is a priority of the clinic staff; the physicians need to be committed to improvement in order for the clinic to be committed.

Each clinic staff should decide how they will improve the care of patients with diabetes.

How Might We Improve Glycemic Control in Our Patients with Diabetes? Some Tools.

Data: Quarterly reports to each clinic that list patient name, PCP, last visit, most recent A1c.

A process that allows clinic staff to complete a lab request for overdue A1c, LDL profile, or urine microalbumin.

Access to the services of Certified Diabetes Educators. ?Group sessions for patients.

Improve self help web-based tools for patients with diabetes.

Point of care A1c testing.

How Might We Improve Glycemic Control in Our Patients with Diabetes?

For those patients who are currently in the “near optimal” control group, moving to “optimal” might mean:

1. Physician, NP, or PA discussing at each visit the benefits of optimal glycemic control.

2. Refresher course on dietary changes for improved control.

3. Regular reminder at visits of the importance of exercise in glycemic control.

4. Medication changes.

How Might We Improve Glycemic Control in Our Patients with Diabetes?

For those patients who are currently in the “poor control” group, moving to “near optimal,” or “optimal,” might mean:

1. Physician, NP, or PA discussing at each visit the benefits of optimal glycemic control.

2. Refresher course on dietary changes for improved control.

3. Regular reminder at visits of the importance of exercise in glycemic control.

4. Medication changes.5. Referral to a Certified Diabetes Educator

How Might We Improve Glycemic Control in Our Patients with Diabetes?

For those patients who are currently in the “not tested” group, the first step is contacting the patient and arranging the testing and an office visit.