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Funding Area: Improving Diabetes Prevention and Management

Health Care Providers Improve Diabetes Care for Patients

Providers from Central New York share their stories about earning national recognition for providing excellent diabetes care from the National Committee for Quality Assurance (NCQA) or Bridges to Excellence (BTE) programs with NYHealth support.

Provider Stories

Brenda Davies-Wait, D.O.
Organization: Bassett Healthcare Network
Location: Cooperstown, NY
Number of Patients: Medium

Dr. Davies-Wait discusses the importance of NCQA recognition, including the benefits of hard patient data and of learning where providers can make improvements.

In your view, what are the most important measurements of quality care required by the NCQA Diabetes Recognition Program?

The HgA1C is the most important measurement. At this point, we know that one of the best ways to assess our management of our diabetic patients is the HgA1C.  However, I do think we need to be careful when we state that good control is for those less than 7%; this could be inaccurate in a practice that is mostly older as most of us are comfortable with HgA1C of 7.5%.

How will NCQA recognition help you enable better care for diabetes patients? Are there any specific positive changes in patients’ health outcomes that you are now expecting to see?

Thinking how you are doing versus knowing are two very different things. The recognition process allows us to see how we are doing with hard data. With the data, we can then make changes in our process. For example, we have made changes to improve our foot exam assessments in the following ways: We now place a footprint on the progress note when diabetic patients come in for a visit to remind the provider to do a foot exam; we will be training our nurses to do foot exams; we also reviewed, as a group, the standards of care and ways we may be able to continue to educate our patients.

Did compiling the data for NCQA’s evaluation help you better organize your patients’ information, or did you already have an electronic record system in place?

With the EMR, patient information is current. We already had the EMR, so there was no change in our organization.

In what ways did you or Bassett Healthcare Network have to adjust policies or practices in order to achieve NCQA recognition?

We did not have to adjust policies or practices.

In your opinion, what is the overall value of recognition programs for diabetes care? Do they encourage providers to adhere to the most updated standards or routines? Does such recognition make it easier to remember to perform needed tests or take certain measurements?

Being recognized allows patients and other providers to know we strive for perfect care. Going through recognition allows providers to assess how they are doing and see areas that they may need to improve on.

Any final thoughts?

I cannot stress how important it is to know where you stand in your practice so you can always make a positive change.

Douglas Rahner, M.D
Organization: Family Health Network
Location: Cincinnatus, NY
Number of Patients: Large

Dr. Rahner says NCQA recognition helped create friendly competition among providers and is valuable for publicly recognizing those who are providing quality care.

In your view, what are the most important measurements of quality care required by the NCQA Diabetes Recognition Program?

I believe blood sugar control (as determined by HbA1c <7% and >9%) and blood pressure control (<130/80 mm Hg and ≥ 140/90 mm Hg) are the most important measurements.

How will NCQA recognition help you enable better care for diabetes patients? Are there any specific positive changes in patients’ health outcomes that you are now expecting to see?

NCQA recognition has enabled better care for patients with diabetes because it allowed the organization to develop policy and procedures to ensure the care was occurring. Also, the measures allowed providers to see actual statistics demonstrating improved diabetes care. NCQA recognition supported the processes that were being followed in the Chronic Care Model.

Did compiling the data for NCQA’s evaluation help you better organize your patients’ information, or did you already have an electronic record system in place?

The organization was already documenting  and tracking the diabetes clinical information through a Diabetes Registry called Patient Electronic Care System (PECS).

In what ways did you or Family Health Network have to adjust its policies or practices in order to achieve NCQA recognition?

It was not an adjustment, but a development of policy and procedure to get patients with diabetes an annual dilated eye exam. The organization needed to develop a process and streamline communications with ophthalmologists in the community.

In your opinion, what is the overall value of recognition programs for diabetes care? Do they encourage providers to adhere to the most updated standards or routines? Does such recognition make it easier to remember to perform needed tests or take certain measurements?

Prior to applying for NCQA DRP (Diabetes Recognition Program), the organization was following a majority of the measures from the Chronic Care Model and had adopted clinical guidelines from the American Diabetes Association Standards of Care. NCQA recognition allowed the organization to make quality improvement to the measures and add the new measure needed to obtain NCQA recognition. The recognition just reinforces the progress the organization has made to address the health care given to patients with diabetes.

Any final thoughts?

It engendered a little bit of competition between providers, which, overall, is helpful in improving performance. It also allowed the organization to formally recognize the providers who have contributed to developing the diabetes program.

About this Initiative

At the close of 2013, NYHealth surpassed its five-year goal of helping 3,000 primary care providers attain recognition from the NCQA and BTE diabetes programs, which is an indicator that clinicians are delivering the best care and achieving good outcomes for patients. By targeting 3,000 doctors, approximately 25% of the 11,000 primary care physicians in New York State, NYHealth expected to set a new standard of care that will lead to a tangible increase in the number of people with controlled diabetes, a decrease in hospitalization rates for people with diabetes, and a decrease in the number of emergency room visits related to diabetes. New York State now has 3,100 providers in solo and group practices, outpatient departments, and community health centers who have attained diabetes recognition with support from the Foundation and its grantee partners.

Providers applied for funds to help achieve recognition through NYHealth’s Meeting the Mark: Achieving Excellence in Diabetes Care request for proposals (RFP). Through this RFP, NYHealth awarded $2,500 per physician who achieved recognition.

Community Health Workers and Congregations Team Up to Fight Diabetes

At the church where Emma Torres worshiped, 60% of her fellow congregants were identified as being at high risk for developing diabetes.

She underwent training to become a community health worker (CHW) and deliver a diabetes prevention and self-management program at her church. Emma and other CHWs across the State are now teaching congregations how to make lifestyle changes to eat healthier, exercise more, and manage stress in order to improve their health and prevent diabetes and its complications.

Through a partnership with NYHealth grantee The Institute for Leadership, the Faith Fights Diabetes initiative has helped congregations across the State launch diabetes prevention and management programs. Volunteers are trained as CHWs to teach a six-week diabetes detection and prevention program at their place of worship. Class topics include risk factors, nutrition, fitness activities, and other healthy lifestyle choices. At the end of the program, participants are encouraged to take these lessons back to their families and communities and to start their own support groups.

This video on the Faith Fights Diabetes initiative shares the stories and experiences of Emma and other CHWs and participants from across the State.

New Yorkers at High Risk for Diabetes Find Help from YMCA Program

At 65 years old, Donald Cortright was diagnosed with prediabetes—a condition that put him at high risk for developing diabetes, heart disease, and stroke. For help in getting his condition under control, Donald went to the Middletown YMCA, one of 10 Ys across the State that have implemented a diabetes prevention program (Y-DPP) with NYHealth support.

“I joined the Y-DPP because my blood test numbers were high. I’m 65 years old. My blood sugar was at 103, my A1C was 6.5, and I weighed 214 pounds [all indicators for prediabetes]. The Y-DPP classes have made me aware that the types and quantity of foods that I eat were a major factor for my physical condition. I was not aware of the total amount of fats and calories that I ate each day. The Y-DPP classes have educated me in a way that I would not have predicted prior to these classes. The instruction and the changes I have made resulted in a weight loss of over 22 pounds, my A1C lowered to 5.6, and my blood sugar is down to 91. I have started walking, riding a bicycle, and doing other forms of exercise most days.

I would recommend this program to anyone who is in need of weight reduction, diet education, or physical activity training. The positive changes that I have seen are life changing. The most useful aspects of the Y-DPP for me are the food and activity trackers, and the calorie-counter book.”

For more than 20 years, Grace Morina had not been able to get below 150 pounds to be healthier, even with the help of dieticians and once under a doctor-managed weight-loss program. After signing up for the Y-DPP in Middletown, she finally met her goal and has maintained the weight loss she needed to help prevent diabetes.

“Not only have the Y-DPP classes given me valuable information, they’ve provided a direction and pace that I was able to include into my lifestyle. The group meetings offered different perspectives and ideas to help with the program. The meetings also provided insight, humor, great suggestions, and a camaraderie that helped immensely. My eating habits and how I respond to the various downfalls have also changed. Even though the program has finished, I know that I have the information and tracking methods to attain my final goal of weight loss and diabetes prevention.

Here are my final outcomes:

  • I met the program’s goal of a 7% weight loss. For over 20 years, I have not been able to get below 150 pounds, even with the help of dieticians and once under a doctor-managed weight-loss program. I’ve finally made it below 150 pounds and have maintained it. For me, this is a miracle.
  • My last blood test reflected that my glucose serum was 89—finally, below the 100 mark. My insulin count was also lower.
  • I am exercising on a regular basis. Through the program I have found the incentive to fit it into my life on a regular basis and overcome issues that prevented me from exercising.
  • I am more aware of food content and I am reading labels on a regular basis, which helps me to eliminate foods at the market before they get home. The program group gave great ideas about foods, cooking, overeating, etc.

I am still working on what I learned through the program, and the book is a valuable resource I will always have. Most of all, the program’s group sessions provided me with encouragement, motivation, and accountability. Watching my food and keeping track of what I eat is now, and always will be, part of my lifestyle.”

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