- © 2008 Marshfield Clinic
Abstract C-C1-03: Moving the Big N
- Ellen Vanderboom, MSN, RN,
- Theodore Praxel, MD, MMM, FACP,
- Marilyn Follen, RN, MSN,
- Daniel Erickson, MD,
- Thomas Gabert, MD, MPH,
- Kori Krueger, MD,
- Eric Penniman, DO,
- Mary Beth Dickinson, RN, BSN and
- Trina Ford, MSN, NP, RD
- Ellen Vanderboom, MSN, RN, Marshfield Clinic; Theodore Praxel, MD, MMM, FACP, Marshfield Clinic; Marilyn Follen, RN, MSN, Marshfield Clinic; Daniel Erickson, MD, Marshfield Clinic; Thomas Gabert, MD, MPH, Marshfield Clinic; Kori Krueger, MD, Marshfield Clinic; Eric Penniman, DO, Marshfield Clinic; Mary Beth Dickinson, RN, BSN, Marshfield Clinic; Trina Ford, MSN, NP, RD, Marshfield Clinic
Abstract
Background: Nationally the trend for hospitalization of diabetics has been slow to show improvement. In 2003, the rate of hospital discharge for diabetes as any-listed diagnosis (360.7 per 1000 people with diabetes) was only slightly lower than the rate in 1980 (398.7 per 1000 people with diabetes). Decreasing hospitalizations and improving health outcomes for 17,678 patients has been a system wide initiative in Marshfield Clinic since 2005.
Methods: Numerous interventions have occurred since 2005 to improve health outcomes and decrease costs for the diabetes population. Evidenced-based guidelines were deployed and CME activities were created for providers. Clinical information support tools and applications deployed included wireless tablets for primary care providers and staff, an electronic point of care reminder tool, medication management and electronic planned care applications were also deployed. The diabetic foot exam process was standardized and medical assistants were trained to perform foot exams. Standing orders for staff to give influenza and pneumococcal vaccinations and schedule necessary lab tests or office visits were developed. Feedback on diabetes quality metrics at the organization, division, department and individual primary care provider level was provided every quarter on a rolling 12-month basis.
Results: The all-cause hospitalization rate for persons with a diagnosis of diabetes has decreased from 360 per 1000 in 2005 to 317 per 1000 in 2007. This decrease in hospitalization lead to improved economic outcomes and quality of life by avoided hospitalizations. Conservative estimates of the cost savings range from $5,202,000 to $14,137,200.
Conclusions: Significant improvement in this population has been demonstrated system wide by a decrease in all-cause hospitalization rates and composite diabetes process and outcome measures. Use of an electronic health record is essential but not sufficient to affect change. Ongoing measurement of practice performance has assisted in the change. Physician champions have been crucial for spread. Improvements are significant, however, opportunities remain.
