Improvement Report: Queens Hospital Center Improves Diabetes Care
Queens Hospital Center
Jamaica, New York, USA
Team
Debra Brennessel, MD, Director, Department of Ambulatory Care Sabira Legesse, Assistant Director, Ambulatory Care
Sameer Misra, MD, Physician, Medical Clinic
Olive Hamilton, RN, Associate Director of Nursing, Ambulatory Care David Reich, MD, Endocrinologist
Richard Arena, RPh, PhD, CDM, Assistant Director of Pharmacy Hildegarde Payne, RN, CDE, Coordinator, Diabetes Center
Shirly Sebastian, NP, CDE, Division of Endocrinology
Hortense Goodwin, Queens College Student Intern
Aim
The Diabetes Management Team will work together to develop and implement a model of comprehensive and coordinated care for patients with diabetes at Queens Hospital Center. Our goal is to improve measurable outcomes by maximizing access, efficiency and follow-up, and by using evidence-based practice guidelines, self-management and specialty referral guidelines.
Measures
Changes
The Diabetes Management Team made changes in key areas of the Chronic Care Model:
Delivery System Design
- Visit redesign: the patient stays put
- Expanded role for Patient Care Associate (PCA): takes patient's shoes off, initiates depression screen
- Change appointment template and start time
- Telephone and mail reminders
- Financial Councilor and cashier assigned to clinic
- Financial Councilors contact self-pay patients ahead of time
Decision Support
- Diabetes practice guidelines established
- Referral guidelines to Diabetes Center
- Data collection tools with built-in reminders (Visit Tracking Forms)
- Implemented EMR with Diabetes Summary (embedded practice guidelines)
Self-Management Support
- Tested action plan and report card (not sustainable)
- Collaboration with Home Care Services for diabetes teaching and self-management
- Group sessions for diabetes teaching depression screening and treatment in clinic
- New CDE from Diabetes Center joined the team and existing member now training for Diabetes
- Education delivered and tested for nursing staff
Community Resources and Policies
- Involvement of Community Advisory Board member to Steering Committee
- Collaboration with Home Care for patient teaching and self-management
Results
      
Summary of Results / Lessons Learned / Next Steps
Lessons Learned:
- Look for newly uncovered efficiencies as redesign proceeds
- Choose “change agents” who really want change
- Use tools or information systems to make care consistent and automatic (“no brainers”)
- Look for community resources and partnerships to help get the work done
- Learn from other teams but test your own changes — they’re more likely to stick
Contact Information
Debra Brennessel, MD, Director, Department of Ambulatory Care Queens Hospital Center
brennesd@nychhc.org
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