Barton County Memorial Hospital
description
Transcript of Barton County Memorial Hospital
Company
LOGO Barton County Memorial Hospital
Providing DSMT in Group Visits in Rural Healthcare Clinics
Leisa Blanchard BSN, RN, CDE, CPT
Eden Ogden BSN, RN, CDE
AADE Annual Meeting 2009Atlanta, Georgia
Session Outline
1. Objectives 1. Objectives
2. Patient Diabetes Education Group Visit2. Patient Diabetes Education Group Visit
3. Plan and Evaluate Patient Education 3. Plan and Evaluate Patient Education
4. Discuss Patient Education Developments4. Discuss Patient Education Developments
Support for this presentation has been provided through a Better Self-Management of Diabetes grant from the Missouri Foundation for Health
Objectives
Presenters will:• Describe a group visit format in rural healthcare
clinics for a non-traditional education program• Discuss the effective implementation of a
wellness and diabetes education program in rural healthcare clinics
• Discuss the opportunities available for non-traditional diabetes education and how to organize a program
• Demonstrate use of outcomes data to support the validity of such programs
Our Mission at BCMH
To provide personalized, humanistic, consumer-
driven healthcare in a healing environment; to empower individuals and families to be actively involved in decisions affecting their care and well-being through information and education; and to provide leadership to improve the health of the community we serve.
Our Journey
A Need
A Program BeginsADA Recognized
2002
PRIMARISCommunity
Care Connection
2004
Missouri FoundationFor Health - Better Self-Management of Diabetes Grant
2006
Barton County Diabetes Education
BSMOD Grantee Map
Program
Inpatient
Group Visits inClinics
Outpatient
Focus
DSMT Group Visits
Organize TreatEducate Evaluate
Program Partners
Physician
CDE Nurse Practitioner
Dietitian
Counselor
Rural Healthcare Clinics
Group Visit
Who Is Served
UninsuredUninsured
Under-insured Under-insured
These services are billable as a physician visit These services are billable as a physician visit
How often? Diabetes wellness visits recommended every 3 months
How often? Diabetes wellness visits recommended every 3 months
Program Design
Acute Care Visit
Wellness Visit
VS
Program Design by Clinics
Patient Rotates to Program Partners Patient Rotates to Program Partners
Program Partners Rotate to Patients Program Partners Rotate to Patients
Program Design
• Patient selection
• Invitation to participate in a “group wellness visit”
• Reminder letter sent two weeks prior to scheduled group visit– Includes request for patient to have labs done
prior to group visit
• Phone reminder the week of the visit
Lockwood Clinic
Lockwood Clinic
Group Visit Content
Presentation Stations Exam Evaluation
•Group Education Presentation
•DVD’s
*Folders*Handouts*Samples*Meters
•Ht. Wt. BMI BP
•Medication/Lab Review•Meal Plan•Foot Exam•Depression
Screen
Diabetes Wellness Visit with Physician or Nurse Practitioner•Med changes•Referrals•Labs•Resources
•Evaluate Pt. Outcomes•Pt Evaluates Group Visit•Providers Evaluate Group Visit•Set/Evaluate Goals
Presentation Curriculum
• Diabetes Overview• Goals for Control• Meal Planning• Label Reading• Holiday Eating• Benefits of Exercise• Monitoring• Stress Management
• Problem Solving• Sick Day
Management• Complication
Prevention• Caring for Feet• Traveling with
Diabetes• Etc.
Plan and Evaluate Patient Education
Followed Meal Plan5 or more servings of
fruits and veggiesPhysical Activity
Testing blood sugar Minutes of moderate
physical activityTake medications/insulin injectionsHemoglobin A1cEye/Foot ExamsQuestions????
Followed Meal Plan5 or more servings of
fruits and veggiesPhysical Activity
Testing blood sugar Minutes of moderate
physical activityTake medications/insulin injectionsHemoglobin A1cEye/Foot ExamsQuestions????
Hemoglobin A1cFollow Meal Plan
Maintain/Lose WeightCheck Feet
ExerciseStop Smoking
Support NetworkCheck Blood SugarYearly Eye Exam
Hemoglobin A1cFollow Meal Plan
Maintain/Lose WeightCheck Feet
ExerciseStop Smoking
Support NetworkCheck Blood SugarYearly Eye Exam
Blood GlucoseLipids
Hemoglobin A1cMicroalbumin
EyesBlood Pressure
Feet
Blood GlucoseLipids
Hemoglobin A1cMicroalbumin
EyesBlood Pressure
Feet
Goals for Control Goals for Control Goal SettingGoal Setting Tell Us How You’veBeen Doing
Tell Us How You’veBeen Doing
Patient Handouts
• Goals for Control– Blood Glucose Level– A1C– Blood Pressure– Lipids– Microalbumin
• Goal Setting – Pick at least one to work on
• Tell Us How You Have Been Doing– On how many of the last seven days did you….
• Followed your eating plan?• Eat five or more servings of fruits and vegetable?• Do physical activity of moderate intensity? How many minutes?• Check your blood sugar as recommended?• Take your recommended medications?
BSMOD Tracking Measures
• Percentage of patients with:– A1C <7%– LDL <100 mg/dl– BP <130/80 mmHg– Average BMI of Patients– Two A1C’s within the last 12 months– Foot exam in the last 12 months– Dilated eye exam in the last 12 months– Documented self-management support goals– Follow-up rating of “4” in at least one goal
Group Appointment Evaluation
Excellent Very Good Good Fair Poor
Info & advice88% 6% 6%
Personal attn88% 6% 6%
Group leaders88% 6% 6%
Involved in care 88% 12%
Medical needs met 87% 13%
Questions answered 87% 13%
Overall group visit 94% 6%
Provider Satisfaction SurveyNot at All
Satisfied
Somewhat Satisfied
Very Satisfied
Extremely Satisfied
Staff helping patients manage their chronic illness?
63% 37%
How satisfied do you think your patients are? 75% 25%Staff involving patients in their own care? 63% 37%Self-management goals assessed in a standardized manner?
13% 50% 37%
Tools & protocols making difference in outcomes? 13% 37% 50%
Format allowed effective care? 13% 37% 50%
Better Self-Management of DiabetesPrimary Care Resources and Supports SurveyPatient Support Scores
1 2 3 4 5 6 7 8 9 10
Individualized Assessment
SMS Education
Goal Setting
Problem-Solving Skills
Emotional Health
Patient Involvement
Patient Social Support
Link to Community Resources
Jul-07 Jul-08 Jul-09
Score
1 2 3 4 5 6 7 8 9 10
Continuity of Care
Coordination of Referrals
Ongoing QI
Systems for Documenting SMS
Patient Input
Integration of SMS into Primary Care
Patient Care Team
Education and Training
Jul-07 Jul-08 Jul-09
Better Self-Management of DiabetesPrimary Care Resources and Supports SurveyOrganizational Support Scores
Score
Better Self-Management of DiabetesPrimary Care Resources and Supports SurveySupport Score Totals
8 16 24 32 40 48 56 64 72 80
Patient Support Score
Organizational SupportScore
Jul-07 Jul-08 Jul-09
Benefits
• Patients use ancillary services
• Referrals increase by word of mouth
• Patients are healthier and better informed
• Hospitalizations are decreased
• Patients build relationships with providers
Sustainability
• A recognized program can bill for DSMT– ADA– AADE
• Community– Conversation Maps– Health Fairs– Group Visits– Wellness Program– Collaboratives– Community Education Presentations
• Grant Acquisition– Networking– Increased Credibility/Visibility– Improved Programming/Policy Change
Questions
?
??
Contact Information
Barton County Memorial Hospital29 NW 1st LaneLamar, MO 64759417-681-5100
• Leisa Blanchard BSN, RN,CDE, CPTDiabetes Education [email protected]
• Eden Ogden BSN, RN, CDEGrant [email protected]