Kansas Department of Health and Environment
Office of Health Promotion
REQUEST FOR APPLICATION:
STATEWIDE DIABETES QUALITY OF CARE PROJECT
All grant applications are due July 15, 2005
For Additional Information, Contact:
Kate Watson
Office of Health Promotion
1000 SW Jackson, Suite 230
Topeka, KS 66612-1274
Telephone: 785-291-3739
Fax: 785-296-8059
Email:
REQUEST FOR APPLICATION
STATEWIDE DIABETES QUALITY OF CARE PROJECT
PURPOSE
To identify fifteen primary care providers (family practice or internal medicine or combination thereof) and/or health care clinics who are interested in improving quality of care for their adult patients with diabetes.
SUMMARY
A grant of $10,000 will be awarded for a 13 month period during which time the grant recipients would agree:
1)To use an electronic patient registry such as the Chronic Disease Electronic Management System (CDEMS) software to enter clinical data for each patient encounter that was scheduled for diabetes disease management (whether or not other conditions are addressed at the same visit), and share aggregate (non-physician specific, non-patient specific) results with the Diabetes Prevention and Control Program (DPCP) and the Kansas Diabetes Advisory Council’s Quality of Care Task Force;
2)To participate in a CDEMS installation and data training meeting prior to implementation;
3)To participate in a one day training conference to learn about the principles of the Chronic Care Model and how it applies to the implementation of the grant requirements;
4)To implement a specified set of office procedures (see page 3) designed to use existing office staff to extend physician care;
5)To provide aggregate data as specified by the DPCP.
6)To participate in monthly conference calls;
7)To provide the DPCP quarterly progress reports;
8)To develop a diabetes team;
9)To identify staff who will comprise the diabetes team.
SOURCE OF FUNDS
The Kansas Diabetes Prevention & Control Program within the Kansas Department of Health and Environment is making these grant awards using funds provided through a cooperative agreement with the Centers for Disease Control and Prevention.
NUMBER OF AWARDS
Fifteen awards will be made.
WHO IS ELIGIBLE TO APPLY?
Physician group practice, individual physician practices, and health care clinics located in Kansas. First consideration will be given to those practices/clinics with at least 100 adult patients with diabetes. However, practices/clinics with less than 100 patients that are willing to include all adult patients with diabetes are encouraged to apply. The applicant practice(s) and clinic(s) should not:
- Have comprehensive diabetes management programs already in place
- Be participating in the National Health Disparities Diabetes Collaborative
- Be participating in Kansas Statewide Diabetes Quality of Care Project – year one.
BACKGROUND
The Wichita Quality of Care Coalition in cooperation with the Diabetes Prevention & Control Program located within the Kansas Department of Health and Environment developed a model for diabetes care quality improvement through a demonstration project in the Wichita community. Diabetes was selected by the Coalition as the initial target disease for quality improvement based on measurable gaps in quality of care and anticipated improvement in patient outcomes.
The Coalition developed a Request for Proposal that was widely disseminated in the Wichita area to identify medical practices in Wichita that would agree to implement the Diabetes Electronic Management system (DEMS) to monitor care for patients with diabetes. The four sites selected included a private physician practice with a high proportion of Hispanic patients, a Primary Care Clinic with a high proportion of African-American patients and two physician practices whose client base was more representative of the general population. All four sites successfully implemented DEMS and three sites continue to monitor patients, improve care, and recommend strategiesto support continued improvement in diabetes quality of care in Wichita. The success of the Wichita pilot sites supported implementing the model statewide.
In December 2004, the Wichita Pilot was replicated in 33 practices/clinics across the state. These organizations represent the Kansas Statewide Diabetes Quality of Care Project. The projected patient registry across all sites is about 14,000 Kansans with diagnosed diabetes. The success of the statewide project supports adding additional sites to the project.
GRANT REQUIREMENTS
1) Use an electronic patient registry such as the Chronic Disease Electronic Management Software(CDEMS) to enter clinical data for each patient encounter that was scheduled for diabetes disease management (whether or not other conditions are addressed at the same visit), and share aggregate (non-physician specific, non-patient specific) results with the Kansas Department of Health & Environment. CDEMS software was designed specifically to aid chronic disease patient management and its use has been shown to improve patient outcomes. While CDEMS has the capacity to capture data related to a variety of chronic diseases, the focus of this project is specific to collecting diabetes data. Entering the data will be the responsibility of grantee; the grant award was specifically intended to offset these and other implementation costs. Grantee data management will give the provider maximum control of confidentiality and data utilization.
While the grantor will not review the performance of any individual physician or patient, it will review an aggregate data report (representing the patients in total) which can be generated from the software at least quarterly. The report will be generated by the physician practice/clinic and should contain no names of patients, providers or practice/clinic. Other use of the data (e.g., reporting to CDC) may be made.
2) Participate in a CDEMS installation and data training meeting prior to implementation.
Non-physician staff will need to be available for a four hour long training session on how to install CDEMS and how to enter and retrieve data from the software. Participating staff will attend the training session at the Kansas Department of Health & Environment in Topeka. Those participants choosing to use an alternate electronic patient registry will still be required to participate in the training.
3) Participate in a one day training conference. Each of the participating physicians and non-physician staff (diabetes team members) will attend a one day training conference to be held in Wichita on September 1, 2005. The focus of the conference will be to provide training to physician and non-physician grantees about the principles of the Chronic Care Model and how it applies to the implementation of the grant requirements and the diabetes standards of care.
4) Implement a specified set of office procedures designed to use existing office staff to extend physician care. Non-physician staff will automatically implement standing orders (unless canceled by the physician for a specific patient) as follows:
Before next visit
a)CDEMS data entry;
b)Review of CDEMS data from last visit with tracking of results of all interim activities (e.g., blood tests, referrals);
c)Placement of CDEMS patient data into the chart;
d)If no HbA1c was ordered in the past six months, order one on or before next visit;
e)If no lipid profile was obtained in the past year, schedule the patient for a fasting lipid profile on or before next visit;
f)If the patient has not had a dilated eye exam in the past 12 months, make a referral to optometry/ophthalmology;
At visit, before seeing physician
g)Monitor and record blood pressure;
h)Measure and record weight;
i)If no urinalysis in the past 12 months obtain urine and dipstick;
j)If urinalysis is negative for protein, and a urinary microalbumen has not been obtained in the past year, place a requisition on the chart for the test;
k)Request the patient to remove socks and shoes in the exam room;
l)Examine feet and record findings and record on the chart any abnormalities;
m)Between October and January, if the patient has not had an influenza vaccine this season, place note on chart for patient to receive one before leaving office;
n)If the patient has never had a pneumovax, place note on chart for the patient to receive one before leaving office.
After seeing physician
o)Schedule the patient for return diabetes visit in three months unless requested sooner by physician;
p)Schedule needed labs and referrals;
q)Deliver needed immunizations.
The grantee will be responsible for any office staff training or system modifications required to implement these office procedures.
5) Provide aggregate data as specified by the DPCP. Aggregate outcome benchmarks will include improvement in HbA1c, complication monitoring (e.g., foot exams, eye exams), and provision of diabetes prevention services (e.g., blood pressure control, frequency of visit, immunizations, diabetes self-management education). Additional measured parameters will include identification of implementation barriers, estimated project implementation costs, and physician/staff satisfaction.
6) Participate in monthly conference calls. The calls are intended to allow grantees to:
- Discuss implementation problems
- Receive technical assistance if needed
- Share best practices.
7) Provide the DPCP quarterly progress reports. The reports will include charts and graphs generated highlighting aggregate data on key diabetes indicators and a narrative describing barriers, successes, and systems changes that have occurred.
8) Develop a diabetes team. Ideally, the team will include a senior leader (generally an executive within the organization), physician/provider champion (principal leader at the pilot site), clinical/technical expert (may include nursing, front office, medical records and information systems personnel), and a team leader (day-to-day leadership and coordination).
9) Identify staff who will comprise the diabetes team. A roster identifying team members’ names, positions, project responsibility and contact information must be submitted to the DPCP.
CRITERIA FOR SELECTION:
The following criteria will be given preference during the selection process:
- Established individual or group physician practices or health clinics located in Kansas.
- Practices/clinics with 100 adult patients with diabetes who agree to track clinical data for those patients using an electronic patient registry, or practices/clinics with less than 100 adult patients with diabetes who agree to track 100% of their adult patients with diabetes.
- Practices/clinics that serve patients with diverse socio-economic status.
- Practices/clinics that serve populations with ethnic and racial health disparities.
- Practices/clinics that do not have comprehensive diabetes management programs already in place.
- Practices/clinics that have the computer capacity (staff and equipment) for implementing an electronic patient registry system.
- Geographic location of the practices/clinics.
OBLIGATIONS OF THE GRANTOR:
The Office of Health Promotion at KDHE or its designee will:
- Provide for physician and non-physician training about the Chronic Care Model as it relates to the implementation of the grant;
- Provide for training of clinic staff in the use of the software;
- Work with the grantee to problem solve during the grant period;
- Conduct regularly scheduled conference calls;
- Provide CDEMS software; and
- Assure confidentiality of clinic/practice specific data.
PROPOSED TIMELINE
July 8, 2005: Pre-Application Conference Call. The purpose of this call will be to answer any questions that applicants may have about the RFA. The call will last from 12:00-1:30pm. To join the conference call applicants should do the following;
- Dial 1-877-278-8686
- Enter the participant code 193983
July 15, 2005: Application to KDHE postmarked
July 19, 2005: Selection of grant recipients
August 1, 2005: CDEMS installation and data training at KDHE
August 2005: Contracts sent to grant recipients
September 1, 2005: One day Chronic Care training conference in Wichita
October 2005: Grantee conference call
November 2005: Grantee conference call
December 2005: Grantee conference call
December 30, 2005: 1st quarter progress report due
January 2006: Grantee conference call
February 2006: Grantee conference call
March 2005: Grantee conference call
March 31, 2006: 2nd quarter progress report due
April 2006: Grantee conference call
May 2006: Grantee conference call
June 2006: Grantee conference call
June 30, 2006: 3rd progress report due
July 2006: Grantee conference call
August 2006: Grantee conference call
September 2006: Grantee conference call
September 29, 2006: Final report due
HOW TO APPLY
Postmarked or faxed by July 15, 2005:
1)The attached one page application form, and
2)A cover letter stating what the applicant hopes to accomplish as a result of this grant.
Send application to:
Kate Watson
Diabetes Prevention and Control Program
1000 SW Jackson, Suite 230
Topeka, KS 66612
Fax# 785-296-8059
1
Statewide Diabetes Quality of Care
Project RFA September 2005-2006
STATEWIDE QUALITY OF CARE FOR DIABETES PROJECT
Cover letter to accompany application described above.
Name of person completing application:
Name and address of group practice:
Names of Applicants
Name / Specialty / Estimated number of diabetic patients cared for1.
2.
3.
At the current time, does your practice/clinic currently use or have:
G Yes G No Diabetes case management
G Yes G No Computerized data for diabetes management
G Yes G No Standing orders for office management of diabetes
G Yes G No A Pentium computer which could be used for diabetes data management
What is the consensus of applicants in regard to the following:
Are ADA guidelines acceptable to you as a standard by which to measure
quality of care?...... YES NO
Do you believe you will be able to find or purchase staff time to enter
patient care data into the software?...... YES NO
Do you believe your staff would be able to successfully implement the
standing orders?...... YES NO
Is participation in this project acceptable to non-participating group partners?...... YES NO
Do you believe you will be able to meet the time commitments of this grant?...... YES NO
1
Statewide Diabetes Quality of Care
Project RFA September 2005-2006