Development-Knowledge Transfer

3. Development-Knowledge Transfer Survey results over time: • Recognition of CCGC name was 49-50% in 2002 moving up to 74% by 2003 • Ranking of most useful guidelines: 2002: Diabetes, Depression, Asthma 2003: Colorectal, Pediatric Immunizations, Diabetes 2009 (May): Asthma, Gestational Diabetes, SBIRT • Sustained interest in having CCGC continue to: • Develop guidelines • Convene stakeholders • Help practices prepare for systems change

4. EVALUATE

5. Guideline Uptake Survey published in Critical Pathways inCardiology (June, 2008) Guideline use before and after dissemination: rates varied between 42.9% and 51.2%

6. Implementation-systems integration Rapid Improvement Activity (RIA) Fit Now Results: By 12 months participants had lost, on average 11.3 pounds when compared to baseline weight (p<.01, 95% CI: 4.3;18.4 pounds) which corresponds to a 5.6% loss of original bodyweight. Changes between 6 and 12 months were not significant.

7. Fit Now Colorado RIA Sites by County: Referrals/Enrollment 92 Patients enrolled

10. SBIRT Colorado Progress to Date • 46,598 patients screened • 54% of patients scored in low or no risk category • 29% scored at risk for tobacco only • 12% scored in moderate risk category (BI) • 2% scored in high moderate risk category (BT) • 3% scored in high risk category (RT)

12. Pneumococcal Immunization Rates

13. Pneumococcal Immunization Rates

15. CCGC Tobacco Program June 9, 2009

16. CCGC Tobacco Team • Co-Directors: • Alison Long, MPH • Michele Patarino, MBA, MSHA • Project Managers: • Debbie Dion • Emily Gingerich

17. Tobacco Program Overview

19. Show Me The Data

20. Tobacco Program Provider Participation www.coloradoguidelines.org/tobacco 6

21. Grants to Healthcare Organizations

22. Grants to Healthcare Organizations MedSouth www.coloradoguidelines.org/tobacco 8

23. Grants to Healthcare Organizations

24. Tobacco Rapid Improvement Activity (TRIA)

25. TRIA’s Examples of Practice Changes Following the TRIA

26. Tobacco Rapid Improvement Activity (TRIA)

27. TRIA Results www.coloradoguidelines.org/tobacco 15

28. IPIP Tobacco Measures

29. 1-800-Quit-Now Additional Data Source: Colorado QuitLine

30. RIA Flyers

31. Questions?VISIT: www.coloradoguidelines.org/tobaccoEmail: tobaccoinfo@coloradoguidelines.org CALL: 720/297-1681

32. Boulder, Colorado http://sprucestreetinternalmedicine.com

33. Hillary Browne, MD, FACP • Colorado Practice Coaches: Debbie Barnett & Deb Maltby • Improving Diabetes Care • Start date: January 2007 • Number of diabetes patients in the registry: ~250

34. Description of Practice • Boulder, Colorado • 3500-4000 active patients, 5% Medicare • 3.5 full time equivalent providers • Aim: to provide excellent, comprehensive diabetes care; NCQA certification • Staff: Manager, Phone receptionist, 2 front office, 4 MAs, 4 file clerks, part time dietician. • Quality improvement team: 1 front office, 1 back office (MA), office manager, 2 providers, QI coach

35. Data collection • Reach My Doctor (RMD): portal with diabetes and asthma registries • Special features we use: • Care plan/flow sheet • labs automatically populate flow sheets • email reminders • labs can be emailed with our comments • patients can view their care plans

36. Planned care at Spruce Street …how it works • Registry • Protocols • Patient makes appointment and DM goes on the schedule • File clerk pulls the chart (red dot) and prints the flow sheet • MA notes that patient has DM and removes patient’s shoes • If annual sensory exam is due, she performs and documents the exam • Visit with provider focuses on flow sheet, which is given to patient at the end of the appointment • Self-management goals and reminder

38. Retinal Exams 6/07 to 5/08 6/08 to 5/09

39. Adopting a clinical protocol: overcoming provider insulin resistance! • Registry enabled us to clearly identify patients with hgb AICs > 9 • Leading to a conscious decision to relearn insulin regimens to achieve better glycemic control • MAs now trained to teach patients to administer insulin and monitor blood sugars

40. Spruce Street Internal MedicineA1c > 9 5/08 to 4/09 6/07 to 5/08

41. Spruce Street Internal MedicineA1c < 7 6/07 to 5/08 5/08 to 4/09

42. Spruce Street Internal MedicineBP < 130/80 6/07 to 5/08 5/08 to 4/09

43. Spruce Street Internal MedicineBP < 140/90 6/07 to 5/08 5/08 to 4/09

44. Spruce Street Internal MedicineLDL < 100 6/07 to 5/08 5/08 to 4/09

45. Spruce Street Internal MedicineKidney Assessment6/07 to 5/08 6/08 to 5/09 6/07 to 5/08

46. Spruce Street Internal MedicineFlu Vaccine 6/07 to 5/08 6/08 to 5/09

47. Spruce Street Internal MedicineFoot Exams 6/07 to 5/08 6/08 to 5/09

48. Sustainable improvement • Routine protocols with immediate correction if not followed • Staff feels responsible and integral to successful patient outcomes • Patients develop stronger connections with ancillary staff • Ultimate outcome is improved satisfaction for patients and staff

49. Next steps • Focus on high-risk patients (hgbAiC > 9) • Challenge ourselves to attain goals on individual diabetes measures. • Asthma registry initiated • Move forward with plan include COPD and heart/stroke • Coordinate timely office follow up after hospitalization to prevent readmission.

50. Thank you • To all of our providers and staff for their exceptional performance • And to Allyson Gottsman, Associate Director, and Marjie Grazi Harbrecht, MD, Medical/Executive Director of the Colorado Clinical Guidelines Collaborative