Abstract
Background: Improvement of diabetes care for a population of 17,993 has been a system-wide initiative since 2004. Multiple strategies have been implemented to meet this aim. The Intervention List, also known as iList, is a software application that was introduced to help physicians and staff plan interventions at the individual patient level to improve care. iList contains lists of patients with diabetes who are not meeting quality metrics and may lack a follow-up appointment.
Methods: Algorithms to identify high-risk patients who are not at goal for diabetes quality metrics and link them to personal care providers were developed by the Data Warehouse. iList was deployed to all primary care practices in the system. Standing orders were developed for staff to use in conjunction with iList to schedule necessary test or office visits. Training was held to assist staff and physicians in improving care through iList, a defect recovery list. In addition, the process of diabetic foot exams was standardized and support staff was trained to perform foot exams
Results: Significant improvement in diabetes care has been demonstrated by the improvement in the composite diabetes process and outcome measures. The percent of patients who have met all diabetes process measures has increased from 13.4% prior to iList implementation to 42.4%. The percent of patients who have met all diabetes outcome measures has increased from 10.1% to 19.1%.
Conclusions: iList has helped physicians and staff to attach names to those patients in their practice who are not meeting all of the quality metrics and take action to improve care where there may be gaps. Awareness of the need to plan chronic care is not necessarily self evident and education of providers and staff has been helpful. Planning care builds trust with patients. Use of the application has emphasized the staffs’ ability to help patients improve their health. Standing orders have facilitated the process of planning care. Planning care saves time and physicians recognize the efficiencies. Adaptive change needs to accompany technical change for successful implementation.
- Received September 11, 2008.
