Angela Herman, MPA

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Improving the Quality of Diabetes Self Management
in Federally Qualified Health Centers in Missouri

• Presented by
• Angela Herman, MPA
• Clinical Program Manager
• Missouri Primary Care Association
• Collaborators
• Carol Brownson, MSPH, RWJF Diabetes Initiative
• Victoria Fehrmann Warren, MS, MO DPCP

CDC Diabetes Translation Conference May 7, 2008
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Learning objectives

• At the end of this session, participants will
• be familiar with the self management support
  assessment tool (PCRS) and its role in quality
  improvement.
• be able to describe a model of collaboration and
  teamwork for improving self management in primary
  care settings  
• be able identify ways to enhance existing
  supports for self-management in their own
  settings

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Partner Organizations
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• Funding was provided in part from the following
  federal sources
• U32/CCU722693-04 Systems-Based Diabetes
  Prevention Control Program
• U50/CCU721332-04 Cardiovascular Health Programs
• U58/CCU722795 Consolidated Chronic Disease
  Prevention and Health Promotion Programs
• Training and technical assistance provided by the
  Robert Wood Johnson Diabetes Initiative

Missouri Primary Care Association
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(No Transcript)
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The Tool Assessment of Primary Care Resources
and Supports for Chronic Disease Self
Management (PCRS)

• A drill down of Self Management Supports in the
  Chronic Care Model
• A self assessment tool for patient care teams in
  primary care settings
• A quality improvement tool
• Two components Patient Support and
  Organizational Support

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Patient Support Component

• Individualized assessment of patient self
  management educational needs
• Self management education
• Goal setting
• Problem solving skills
• Emotional health
• Patient involvement in decision making
• Social support
• Links to community resources

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Organizational Support Component

• Continuity of care
• Coordination of referrals
• Ongoing quality improvement
• System for documentation of SM support services
• Consumer participation/ Patient Input
• Integration of SM support into primary care
• Patient care team/ team approach
• Staff education and training

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PCRS is.

• User friendly
• Consistent with current best practices in quality
  improvement and chronic illness care
• Broadly applicable (i.e., works in different
  types of settings as well as for different
  chronic conditions)
• Publicly available under Lessons Learned on the
  Diabetes Initiative website http//diabetesinitiat
  ive.org

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Sample PCRS section
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Train the Trainer Course

• Self-management 101 for CHC staff included
• training on self-management support
• practice developing action plans
• skills needed to assist patients with problem
  solving skills
• the difference between self-management education
  and self-management support

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Quality Improvement Tracking

• Centers identified patient support characteristic
  chosen and organizational support characteristic
  chosen
• For each area asked the centers to provide the
  following
• Rationale for choosing components
• Describe major steps taken to make changes in
  chosen components
• Were there things that really helped you as you
  went through your processes?
• Barriers/obstacles encountered? If so, how did
  you overcome?
• Outcome of the change

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Results Patient Support - Characteristic Selected
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Results Organizational Support - Characteristic
Selected
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Example QI Strategies forPatient Care Team

• Planned and conducted staff in-services
• Defined specific tasks for team members
• Worked on re-designing visit
• Included all staff in collaborative meetings
  oriented all staff to the collaborative

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Example QI Strategies for Goal Setting

• Education/ awareness
• Provider meetings
• In-service on goal setting
• Improved processes
• New forms
• Better tracking of patient progress toward goals
• Reminders on patient charts
• Improved practice
• Address SM goals at every visit

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Example QI Strategies for Patient Involvement

• More information
• Tracking form revised 1 copy to patient
• Educational information in multiple languages
• More services
• New diabetes educatormore one on one and follow
  up
• New classes
• Patient input into decision making
• Patient made captain of healthcare team
• Invited patients to be on advisory board

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Documentation of Self-management Goal Setting

• Documentation of self-management goal setting for
  diabetes in August 2006 was at 43.2
• Documentation of self-management goal setting in
  May 2007 at the conclusion of the one year PCRS
  project was 51.5
• Documentation of self-management goal setting in
  November 2007 six months after the conclusion of
  the project was 52.7

Missouri Primary Care Association
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Lessons Learned in Missouri

• FQHCs improved functioning of the patient care
  team
• Enhanced ability to provide more
  patient-centered care
• Good relationships help improve the capacity for
  self management support!

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• Contact Information
• Angela Herman, MPA
• Clinical Program Manager
• Missouri Primary Care Association
• E-mail aherman_at_mo-pca.org
• Phone [phone]