Type II Diabetes Screening Christy Holshouser RN BSN, UASON FNP Student
MEDICAL ASSOCIATES OF DAVIE OWNERSHIP: Novant Health, not-for-profit, integrated healthcare system that serves people in Virginia, North Carolina, South Carolina and other regions. HISTORY: Medical Associates of Davie is a part of Forsyth Medical Group that opened on it’s current location 15 years ago. Today there is also a satellite practice site in Advance, N.C..
PREDOMINANT SOURCE OF REVENUE: Private Insurance ANNUAL NUMBER OF VISITS: Approximately 36,000 (average 3,000 per month)
HOURS OF OPERATION: •Monday to Friday 7:30am-5:30pm •Saturday 8am – 12pm •Sunday 1pm – 5pm
MEDICAL ASSOCIATES OF DAVIE FOCUS : Delivering excellent patient care
MISSION: Novant Health exists to improve the health of our communities one person at a time. VISION: We, the employees of Novant Health and our physician partners, will deliver the most remarkable patient experience, in every dimension, every time.
PHILOSOPHY OF PRACTICE: COMPASSION: We treat our customers and their families, staff and other healthcare providers as family members with kindness, patience, empathy and respect. DIVERSITY: We recognize that every person is different, each shaped by unique life experiences. This enables us to better understand each other and our customers. PERSONAL EXCELLENCE: We strive to grow personally and professionally and approach each service opportunity with a positive, flexible attitude. Honesty and personal integrity guide all we do. TEAMWORK: The needs and expectations of any one customer are greater than what one person's service efforts can satisfy. We support each other so that together as a team, we can be successful in the eye of the customer as a quality service provider. http://www.novanthealth.org/about_novant_health/company_information.jsp
DEMOGRAPHICS DAVIE COUNTY – RURAL LAND AREA: 265.18 SQUARE MILES METROPOLITAN AREA: WINSTON SALEM, N.C.
2009 CENSUS BUREAU •Population: 41,420 •Persons <18yrs of age: 23% •Persons >65 yrs of age: 14.9% •Median age: 39 •Median income: $52,408 •High school graduate: 78% •Disabled persons >5 yrs of age: 6,983 •Persons below poverty level: 10.8% •Employed persons: 22,141 •# Insured under the age of 65: 27,503 •# Uninsured under the age of 65: 7,079 •Largest occupational employer: Machine operator, assembler, and inspector •Largest industry employer: Manufacturing durable goods
COMMUNITY RESOURCES Family Services of Davie County Social Services of Davie County Davie County Health Department Davie County Senior Services Psychiatric services: Daymark Recovery United Way American Red Cross Vocational Rehab of Davie County Store House for Jesus (Free Clinic provided) Davie County Hospital Davie County Home Health Autumn Care Nursing Home Davie Place Residential Care – Assisted Living Pharmacies: CVS, Walgreens,Walmart, Foster’s Drug Urgent Care Facilities: Medical Associates of Davie, WFUBMC Health Care Center, Davie Primary and Urgent Care
IDENTIFIED COMMUNITY NEEDS PRIMARY FOCUS: Unidentified population at risk for Type II Diabetes; risk increases with age, obesity and decreased physical activity SECONDARY FOCUS: Hypertension Obesity Hyperlipidemia Hyperglycemia
METHODS USED TO ADDRESS NEEDS: Screening for Type II Diabetes • Fasting plasma blood glucose • Oral glucose tolerance test Risk Screening Tool (RST) to identify the target population
DIABETIC SCREENING: ADULTS
DIABETIC SCREENING: CHILDREN AND ADOLESCENTS RECOMMENDATIONS: ¾ ¾
Testing every 2 years beginning at the age of ten or at puberty if younger Criteria: •Overweight ¾ >85th percentile for age and sex ¾ Weight for height >85th percentile ¾ Weight >120% of ideal body weight for height
AND •Two of the following risk factors: ¾ Family history of Type II Diabetes in 1st or 2nd degree relative ¾ Race/Ethnicity (Native American, African American, Hispanic, Asian, South Pacific Islander) ¾ Signs of insulin resistance: • Acanthosis nigricans • Hypertension • Dyslipidemia • Polycystic Ovary Disease Acanthosis nigricans
SCREENING METHOD IN PRACTIC OBJECTIVES • To identify patients at risk • To increase the rate of appropriate interventions for patients at risk
OUTCOMES
• Cost effectiveness of preventative care • Decrease in progression to diabetes • Decrease in microvascular damage
IMPLEMENTED • Educate the medical staff : (Physicians, Practitioners, Nurses, Aides) ¾In-services with follow-up questions ¾Computer based training • Identify the target population: ¾Nursing staff to identify patients who meet weight and blood pressure criteria ¾Risk Screening Tool initiated by nursing staff and placed in patient chart for further assessment during office visit ¾Visual cues placed at nurses station as a reminder of the RST • Educate the community: ¾Informational brochure ¾Counseling during office visits for patients at risk
METHOD IN PRACTICE… EVALUATED • Audit at one week, one month, and three months to assess: ¾Percentage of patients who met criteria ¾Percentage of tools placed on chart ¾Percentage of tools actually used by physician/practitioner •5-item Lickert scale at one week, one month, and three months to assess: ¾Perception of risk assessment tool • Ease of use • Perceived value ¾Process of risk assessment tool •Audit at one month and three months to assess accuracy rate (number of the identified population that met criteria and were proven, by diagnostic testing, to have Type II Diabetes)
METHOD IN PRACTICE… SUSTAINED •Support through governing body of the medical office •Presentation to medical and nursing staff of the results of the audits and assessments •Implementation into other Novant Health Group offices
NURSE PRACTITIONER ROLE •Physician collaboration •Educate medical and nursing staff regarding research based outcomes of Type II Diabetic screening •Aid in education of the medical personnel regarding: ¾Proper technique of BP assessment ¾Proper calculation of BMI ¾Identification of population at risk •Adult criteria •Child/Adolescent criteria
REFERENCES Center for Medicare & Medicaid Services (CMS). Diabetes screening tests. Washington, DC: CMS; 2005. Retrieved June 12, 2010, from http://www.cms.hhs.gov/DiabetesScreening/ Cooksey C, Allweiss P, Campbell KP. Diabetes evidence-statement: screening. In: Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006. Retrieved June 12, 2010, from http://www.businessgrouphealth.org/preventive/topics/diabetes.cfm Feig DS, Palda VA, Lipscombe L. Screening for type 2 diabetes mellitus to prevent vascular complications: updated recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2005 Jan 18; 172(2): 177-80 [44 references]. Retrieved June 10, 2010, from PubMed. Kahn, R., Alperin, P., Eddy, D., Borch-Johnsen, K., Buse, J., Feigelman, J. et al. (2010, April 17). Age at initiation and frequency of screening to detect type 2 diabetes: A cost effectiveness analysis. The Lancet, 375(9723), 1365-1374. Retrieved June 10, 2010 from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62162-0/abstract#aff1 Norris SL, Kansagara D, Bougatsos C, Nygren P. Screening for Type 2 Diabetes: Update of 2003 Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 61. AHRQ Publication No. 08-05116-EF-1. Rockville, Maryland: Agency for Healthcare Research and Quality. June 2008. Retrieved June 12, 2010, from http://www.ahrq.gov/clinic/uspstf08/type2/type2art.htm Rutten, G. (2010, April 17). Screening for type 2 diabetes - where are we now? The Lancet, 375(9723), 1324-1326. Retrieved June 10, 2010, from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)621620/abstract#aff1