A PEEP Into Practice A WinWin Education and

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A PEEP Into Practice: A Win-Win Education and Quality Improvement Project With Community Preceptors

A PEEP Into Practice: A Win-Win Education and Quality Improvement Project With Community Preceptors The Practice Education and Enhancement Project in Diabetes Mellitus Caryl Heaton, DO Robin Schroeder, MD Chantal Brazaeu, MD New Jersey Medical School - UMDNJ

PEEP-DM n Goals of this presentation 1) Describe the program 2) Describe introduction to

PEEP-DM n Goals of this presentation 1) Describe the program 2) Describe introduction to preceptors 3) Describe the results so far 4) Give suggestions for reproducing this program

The Patient Centered Medical Home n “Quality and safety are hallmarks of the medical

The Patient Centered Medical Home n “Quality and safety are hallmarks of the medical home: Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement”*. n*http: //www. patientcenteredprimarycare. org/JOINT_PRINCIPLES. pdf

Our Goal n to teach quality assessment and improvement to students n simultaneously support

Our Goal n to teach quality assessment and improvement to students n simultaneously support (give back to) preceptors in advancing their QI efforts and help with ABFM requirements

The PEEP DM Project n n Student Introduction and Instructions Data Gathering and Entering

The PEEP DM Project n n Student Introduction and Instructions Data Gathering and Entering Students gather data on 10 patients ¨ Enter the results in Web CT ¨ n n Results and QI Discussion Results to Preceptor Faculty

Top half of Indicator sheet

Top half of Indicator sheet

Bottom Half of Indicator sheet

Bottom Half of Indicator sheet

Collecting the Data Each student “interviews” 10 diabetic patients and reviews the chart (NCR

Collecting the Data Each student “interviews” 10 diabetic patients and reviews the chart (NCR paper form) n No patient identification information is transmitted to the school ¨Copy of form is kept by preceptor n Student enters patient indicator data via Web. CT n Transferred to Excel for statistical analysis n Will use SPSS in the future n

Results/QI Seminar

Results/QI Seminar

PEEP Results – CFM 07 -1 For diabetic patients seen in teaching practices…. 167

PEEP Results – CFM 07 -1 For diabetic patients seen in teaching practices…. 167 patients entered n Average Hg. A 1 c = 7. 51 n Average LDL = 112 n Average BP = 133/81 n

Reporting “by patient report” n % of patients that had ¨ Hg. A 1

Reporting “by patient report” n % of patients that had ¨ Hg. A 1 C in last 6 months ¨ Feet checked in last 6 months ¨ Urine checked in last year ¨ Smoke n Had been advised to quit ¨ Eye exam in last year ¨ Cholesterol checked in last year ¨ Blood pressure checked ¨ Do you know your target BP? 89% 80% 74% 23% 86% 74% 95% 100% 70%

Reporting – “by chart review” n % of patients that had done in last

Reporting – “by chart review” n % of patients that had done in last 6 months----- ¨ 88% ¨ Hg. A 1 C less that 9, ----------¨ 43% n and less than 7 -----------¨ Feet checked in last 6 months---- ¨ 73% ¨ Had check for albuminuria------ ¨ 69% ¨ 93% ¨ Told to quit smoking --------¨ Eye exam report charted in last year- ¨ 47% ¨ LDL checked in the last year------ ¨ 100% ¨ Had an LDL ≤ 100 ------------ ¨ 36% ¨ Had their blood pressure checked------¨ 100% n Had a systolic ≤ 130, diastolic ≤ 80 ¨ 56% ¨ Hg. A 1 C

Other Results Patient vs Chart ¨ Hgb. A 1 C ¨ Feet Check ¨

Other Results Patient vs Chart ¨ Hgb. A 1 C ¨ Feet Check ¨ Cholesterol/LDL ¨ Eye Exam 89% vs 88% 80% vs 73% 95% vs 100% 74% vs 47%

How many had all of these measures at target? n BP Sys, BP Dias,

How many had all of these measures at target? n BP Sys, BP Dias, LDL, Hg. A 1 C 4. 2%

Intervention Grid n n n Provided at the debrief session Examples are given Data

Intervention Grid n n n Provided at the debrief session Examples are given Data collected about what students observe in practices

Compare your Office What was your office especially good at? n What techniques seemed

Compare your Office What was your office especially good at? n What techniques seemed to work in your office? n What things could be done better? n

Foot Exam stickers for chart

Foot Exam stickers for chart

Posters for the Wall

Posters for the Wall

Diabetic Dilated Eye Exam Fax Back Report

Diabetic Dilated Eye Exam Fax Back Report

Patient Education Sheet

Patient Education Sheet

Patient Self Assessment Tool

Patient Self Assessment Tool

Next Steps: Compare results between practices n Using data from the intervention sheet (student

Next Steps: Compare results between practices n Using data from the intervention sheet (student report) we will try to identify activities that are associated with better outcomes n Feedback to preceptors…. n

Questions?

Questions?