Diabetes mellitus treatment using a bundle of diabetes measures and electronic health record tools reduced the risk of retinopathy, stroke and myocardial infarction within three years at Danville, Pa.-based Geisinger Health System, according to a commentary (pdf) in the Learning Health System Commentary Series of the Institute of Medicine Roundtable on Value & Science-Driven Health Care.
A multispecialty, multidisciplinary group at Geisinger Health System designed a team-based care plan that involved an all-or-none bundle of diabetes measures to ensure all patients received all elements of care. This bundle included the following nine measures and the accompanying quality standard:
• HgbA1C measurement: Every six months
• HgbA1C control — patient-specific goal: Less than 7 percent or 7 to 8 percent
• Low-density lipoprotein measurement: Annually
• LDL control — patient-specific goal: Less than 70 mg/dl or less than 100 mg/dl
• Blood pressure measurement: Less than 140 systolic blood pressure, less than 80 diastolic blood pressure
• Urine protein testing: Annually
• Influenza immunization: Annually
• Pneumococcal immunization: Once before 65, once after 65
• Smoking status assessment: Nonsmoker
The bundled system of care was established in community practice service lines in 2005. Results showed significant lower risk of macrovascular and microvascular disease endpoints in the first three years in the new system compared to primary care outside the system, according to the commentary.
"The promising success of this new system hinged on creating a culture of team-based care, judicious use of EHR tools, having accurate clinical information, and aligning team incentives," the authors wrote in the commentary.
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A multispecialty, multidisciplinary group at Geisinger Health System designed a team-based care plan that involved an all-or-none bundle of diabetes measures to ensure all patients received all elements of care. This bundle included the following nine measures and the accompanying quality standard:
• HgbA1C measurement: Every six months
• HgbA1C control — patient-specific goal: Less than 7 percent or 7 to 8 percent
• Low-density lipoprotein measurement: Annually
• LDL control — patient-specific goal: Less than 70 mg/dl or less than 100 mg/dl
• Blood pressure measurement: Less than 140 systolic blood pressure, less than 80 diastolic blood pressure
• Urine protein testing: Annually
• Influenza immunization: Annually
• Pneumococcal immunization: Once before 65, once after 65
• Smoking status assessment: Nonsmoker
The bundled system of care was established in community practice service lines in 2005. Results showed significant lower risk of macrovascular and microvascular disease endpoints in the first three years in the new system compared to primary care outside the system, according to the commentary.
"The promising success of this new system hinged on creating a culture of team-based care, judicious use of EHR tools, having accurate clinical information, and aligning team incentives," the authors wrote in the commentary.
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