Borgess Medical Group launched an ambitious initiative to curb the rate of patients with uncontrolled diabetes by 20 percent in fewer than 90 days—and not only did the medical group exceed its target, but its success spurred Ascension Health Michigan to adopt similar goals in a statewide initiative, Mike Miliard writes for Healthcare IT News.
A lofty goal
The initiative was part of a broader challenge by Borgess Health—a member of Ascension Health—which tasked its medical groups with improving a quality metric of their choice by 20 percent in the final fiscal quarter of 2015.
Reflecting on the challenge at HIMSS Pop Health Forum on Monday, Cindy Gaines, VP and COO of Borgess Medical Group, the said the goal was particularly lofty considering many health organizations do not even try to effect a 20 percent change over the course of a full year.
How the process works
Gaines and her team selected uncontrolled diabetes as their quality metric, and they focused on patients who had hemoglobin A1c levels greater than nine.
To accomplish their goal, the team first looked at the data they had on their patients and then challenged themselves to overcome their "experience bias" and think of new, simple ways to engage patients, Gaines said. Ultimately, the team identified 1,769 patients as having unchecked A1c levels and tried reaching out to those individuals via multiple methods, including:
- Care coordinator outreach;
- Clinical pharmacist review;
- Computerized phone messaging;
- Emails delivered through the patient portal;
- Letters with both lab orders and test tracking information; and
- Personal phone calls.
The team then assessed which approaches were most successful. They found that:
- Care coordinators were the most successful, with 35.3 percent of patients being receptive to them;
- Clinical pharmacist review was the next-most successful, at 18.1 percent;
- Letters at 12.2 percent;
- The portal message at 8.2 percent;
- Computerized phone calls at 7.8 percent; and
- Personal phone calls at 6.6 percent.
Ultimately, the series of strategies worked better than the team could have expected, Miliard writes, cutting the medical group's rate of patients with uncontrolled diabetes by 29 percent in February 2015. And while the hospital's improvement rate declined a bit in later months, Borgess Medical Group was still able to maintain the 20 percent total reduction for the fiscal quarter.
In fact, given the program's success, Ascension Health Michigan made lowering hemoglobin A1c levels by 15 percent a statewide goal for the next fiscal year.
Meanwhile, according to Gaines, Borgess has invested in a population panel coordinator and continued to use care coordinators to engage patients with A1c levels above nine. "We achieved our goal of 15 percent," Gaines said. "And we have hardwired an ongoing process for this metric and many more" (Miliard, Healthcare IT News, 10/3).
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