1. Quality Measures in
Diabetics
QIP Project
Shaun Cole, M.D., M.P.H
Patrick Smithedajkul, M.D.

2. Problem Statement
• Successful diabetes management can be
assessed using markers of target processes,
such as Hb A1c, LDL and blood pressure.
• Diabetic patients are not meeting quality goals
in the Baldwin PCIM clinic.

3. Root Cause Analysis

4. Magnitude
•Among US residents >65 years, 26.9% had DM in
2010
•Leading cause of kidney failure, NT lower-limb
amputations and new cases of adult blindness in the
US
•Major cause of heart disease and stroke
•7th leading cause of death in the US
•PCIM chart review - pending

5. Magnitude
• $174 billion:Total costs of diagnosed diabetes in
the United States in 2007
• $116 billion for direct medical costs
• $58 billion for indirect costs (disability, work loss,
premature mortality)

6. Magnitude
• Quality measures (LDL, blood pressure, Hgb A1C)
• What percentage of our diabetic patient’s have goal metrics in
all three?
• Answer: 20.3%
• What percentage of the consultant’s diabetic patients?
• Answer: 30.2%

7. Why Should We Care?
• For every 1% decrease in HbA1c, the chances of blindness,
amputations and renal disease decreases by 35% (Level A)
• Reduction of LDL below 100 and systolic BP les than 130
reduced CVD 40-50% (Level A)
• ADA clinical practice guidelines can be found at
www.diabetes.org

8. Stakeholders
• Consultants
• Residents
• Diabetic Care Managers
• Nursing staff
• Patients

9. Potential Interventions
• Resident Education to increase clinical guidelines
awareness
• Quarterly reports of patients’ metrics
• One-on-one time with diabetic care managers to
discuss critical gaps in management and patient
approach

10. Costs/Benefits
• Minimal costs
• Diabetic care managers already present
• Amalga Database present
• May take months to see benefit
• Potential risks- minimal
• Potential benefits- reduction in morbidity and
mortality, better relationships, save money in
healthcare, foster team-building in the workplace

11. Methods and Assessment
• Prospective cohort
• Between 4 firms, two will receive quarterly reports and
visits with care managers (intervention arm) and two will
receive “as needed” care manager time and reports
• Each quarter, quality metrics will be assessed
• Allows for both longitudinal progress of interventional arms
as well as direct comparative assessments to control arms

12. Methods and Assessment
• DM care manager time measurements
• compared between two cohorts
• Resident satisfaction
• assessed at the end of the intervention period using a 4-
point Likert scale
• DM Care manager satisfaction
• single focus group conducted at the end of 1 year

13. References
• Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates
and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA:
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
2011.
• Agency for Healthcare Research and Quality
www.ahrq.gov/browse/diabetes.htm
• American Association of Diabetes Educators
www.diabeteseducator.org
• American Diabetes Association
www.diabetes.org