Jolene Johnson, MD Associate Clinical Professor of Medicine, LSU School of Medicine

Jolene Johnson, MDAssociate Clinical Professor of Medicine, LSU School of MedicineHead, Statewide Diabetes Disease Management, LSU HCSD

Diabetes Disease Management Update

OverviewCurrent MeasuresAddition of CVD LSU ICON ProjectsGoals

1485

2705

1441

2958

1798

2150

1666

14203

.25

.3

.35

.4

.45

.5

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SITES over QUARTERSGraph uses data from quarters 200901 through 201301AWARD criterion = 0.40, GOAL = 0.40, see lines on graph

diabetes: last BP <= 130/80denom: MedHm sustained 6/12

1104

1893

986

2006

1317

1370

838

9514

.2

.3

.4

.5

.6

.7

.8

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diabetes: Eye exam in past 12 mosdenom: MedHm sustained 3/12

11041893

986

2006

1317 1370

838

9514

0

.1

.2

.3

.4

.5

.6

.7

.8

.9

1

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diabetes: Foot exam in past yeardenom: MedHm sustained 3/12

1334

2515

1313

2846

1691

17181497

12914

.4

.45

.5

.55

.6

.65

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diabetes: HbA1c 12 mos <= 7%denom: MedHm sustained 6/12

1104

1893

986

2006

1317

1370

838

9514

.6

.65

.7

.75

.8

.85

.9

.95

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diabetes: HbA1c in past 6 monthsdenom: MedHm sustained 3/12

1142

2148

1052

2456

1571

1498

1229

11096

.45

.5

.55

.6

.65

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diabetes: LDL 12 mos <= 100denom: MedHm sustained 6/12

1104

1893

986

20061317

1370838

9514

.7

.75

.8

.85

.9

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SITES over QUARTERSGraph uses data from quarters 200901 through 201301

diabetes: LDL test in past 12 mosdenom: MedHm sustained 3/12

992

1876 863

1789

1296

1175

775 8766

.75

.8

.85

.9

.95

1

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diabetes: RENAL, renal assessment in past yeardenom: MedHm sustained 3/12

Diabetes and Cardiovascular Disease

1104

1893 986

2006

1317

1370

838

9514

.15

.2

.25

.3

.35

.4

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diabetes: IVD/CAD %denom: MedHm sustained 3/12

360332

174 767

327 370

194

2524

.2

.25

.3

.35

.4

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.5

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diabetes: last BP <= 130/80denom: MHCD sustained 3/12 IVDCAD

289

277

145

673

284

299

150

2117

.2

.25

.3

.35

.4

.45

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diabetes: LDL 12 mos <= 70denom: MHCD sustained 3/12 IVDCAD

267

256

132

625

272

275

106

1933

.15

.2

.25

.3

.35

.4

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diabetes: LDL sustained above 100denom: MHCD sustained 3/12 IVDCAD

69

82

26

162

80 58

36

513

.1

.15

.2

.25

.3

.35

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diabetes: Change in statin therapy, LDL > 100denom: MHCD sustained 3/12 IVDCAD

Disease Management & LSU ICON

Benefits of LSU ICON for Diabetes Disease ManagementDiabetes Interest Group

◦Assisting Diabetes Management Group in the development and testing of procedures associated with the expansion of the scope of its programs and services Diabetes Screening Techniques Treatment Strategies for Pre-

Diabetes Hepatitis B Immunization

Current LSU ICON Diabetes Disease Management Projects

Implementing Screening for Diabetes and Pre-Diabetes within the LSU HCSD Medical Home

ClinicsJolene Johnson, MD and Ronald Horswell, PhD

Principal InvestigatorsJay Besse, BS and Rob Leonhard, MBA

Co-Investigators

Designing Screening Algorithms for Diabetes and Pre-Diabetes

Ronald Horswell, PhD Principal Investigator

Gang Hu, MD, PhD and Jolene Johnson, MDCo-Investigators

Implementing Screening for Diabetes and Pre-Diabetes within the LSU HCSD Medical Home Clinics

Overview: This Quality Improvement project pilots

a specific diabetes screening protocol and follow-up program.

This pilot was conducted at three LSU HCSD medical home clinics.

If the pilot protocol and follow-up program prove feasible and sustainable, they will be implemented at other LSU HCSD medical home clinics.


Project was piloted for 2,830 patients who visited three Medical Home Clinics at Earl K. Long from January 14, 2013 to February 28, 2013.

◦North Baton Rouge◦South Baton Rouge◦Family Practice Clinic


Exclusion by Administration

Data ?

Screened?

Screening stop boxes for exclusion?

Yes

No

NoYes

YesNo

Unique visitors (2830) A

Visitors (1714) D

Screened (841) F

Existing Diabetes Diagnosis (75)G

Recently Tested (371) H Ordered

(190) M

Done (130)O

Age<45 & BMI<25 (51) I

Normal (55) Q

Pre-diabetes

(63) R

Diabetes (12) S

Pending (60) P

Not Ordered (22) N

2+ Risk Factors (212) K

Not screened

(833) E

Diabetes (817) B

Less than 2 Risk Factors

(132) L

Cancer, HIV or

ESRD (229) C

Risk Factors

Assessed (344)J

Group Name (# of

subjects)

Decision

Legend


Results: 5.7%

Prevalence of previously undiagnosed patients with diabetes identified among

those with two or more risk factors visiting the pilot clinics

Based upon the LSU HCSD Medical Home volume of 101,000 unique adult patients

annually, 1420 patients would be identified by the screening protocol as having diabetes if

conducted for one year


Results:29.9%

Prevalence of previously undiagnosed pre-diabetic patients among those with two or more risk factors visiting the pilot clinics.

Based upon the LSU HCSD Medical Home volume of 101,000 unique adult patients

annually, 7,470 patients would be identified by the screening protocol as having pre-

diabetes if conducted for one year

Overall Impact of Projects on Improvement of Health Outcomes

The identification of a large number of undiagnosed patients with pre-diabetes

highlights the need for a treatment strategy. Therefore, feasible and

inexpensive interventions for patients with pre-diabetes should be defined and

tested.

Current LSU ICON Diabetes Disease Management Projects

Implementing Screening for Diabetes and Pre-Diabetes within the LSU HCSD Medical Home

ClinicsJolene Johnson, MD and Ronald Horswell, PhD

Principal InvestigatorsJay Besse, BS and Rob Leonhard, MBA

Co-Investigators


Ronald Horswell, PhD Principal Investigator

Gang Hu, MD, PhD and Jolene Johnson, MDCo-Investigators


Overview:This Quality Improvement Project is

gathering data necessary to evaluate alternative screening algorithms for identifying previously undiagnosed patients with diabetes and pre-diabetes.

The immediate application of these results will be the development of a cost effective screening algorithm(s) for use within the LSU Health delivery system.


Results:

Risk factor screening instruments, utilized as typically recommended (e.g.: ADA 2+ risk factors), reduce the cost per person screened, but have a maximum sensitivity of 80%.

Suggests the need to be selective in establishing screening instrument cut off points.

Overall Impact of Project on Improvement of Health Outcomes

To maximize the sensitivity and minimize the cost of diabetes

screening

Proposed LSU ICON Diabetes Disease Management Project

Comparing Cost Effectiveness of Two Methodologies for Assessing Diabetic Patients for Hepatitis B

Vaccines Within the Medical Home Clinic

Jolene Johnson, MD and Ronald Horswell, PhD

Principal Investigators

Proposed LSU ICON Diabetes Disease Management ProjectOverview:Two general strategies for Hepatitis B

vaccination◦ Test for immunity prior to vaccination◦ Immunize all patients

Critical information for determining optimal strategy includes: ◦ Cost of immunity testing◦ Cost of immunization◦ Baseline prevalence of immunity in the population

Goals Implementation of Diabetes

Mellitus screening Identification and piloting of

interventions related to Pre-diabetes

Continued Population Management with private partner

Jolene Johnson, MD Associate Clinical Professor of Medicine, LSU School of Medicine

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