Kansas Quality of Care Project

Submission Date: December 2013

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Kansas

States/Territories Involved: Kansas

Domain Addressed:

Health Systems Strategies

Public Health Issue:

Health Resources and Services Administration (HRSA) Diabetes Health Disparities Collaboratives successfully applied evidence-based methods to generate improved health outcomes for underserved populations by transforming clinical, operational, and financial practices through the Expanded Care Model and the Model for Improvement.

Applying similar methods can lead to similar improvements for primary care practices treating patients with diabetes.

Project Objectives:

The objective of this project was to improve the quality of care being given to patients with hypertension by tracking standards of care for hypertension patients, utilizing the Chronic Care Model to impact the way care is provided at the system level and organizing a multidisciplinary team to provide care for patients.

Program Action:

The Kansas Quality of Care (KQOC) Project was a modified version of HRSA’s Diabetes Health Disparities Collaborative designed to address the significant diabetes burden in Kansas, particularly among lower-income populations and racial/ethnic minorities. Participating providers, mainly primary care practices, collected registry data in the Chronic Disease Electronic Management System (CDEMS) and/or through electronic health records and sent data to the Kansas Diabetes Prevention and Control Program (DPCP) for analysis. The DPCP worked with providers to improve quality of care based on analyzed registry data.

Following a successful pilot project in one site and with CDC and Kansas Office of Local and Rural Health (OLRH) funding, the KQOC Project was able to support a total of 35 sites, sustained through continued OLRH funding.

Hypertension and hyperlipidemia components were added to the KQOC Project as a result of supplemental funding received by the  Kansas Heart Disease and Stroke Prevention program

Data/Other Information Collected:

Diverse participating organizations included local health departments, community health clinics, safety net clinics, American Indian health clinic, & private practices.

Data were collected on the following:
HbA1c Tests
BP
Foot Exams
Eye Exams
Flu Vaccinations
Pneumonia Vaccinations
Patients Self Monitoring Blood Sugar
Diabetes Education Provided
Nutrition Education Provided
Patient Self-management Goals Set
Smoking Cessation Counseling Provided
BMI Calculated
Blood Pressure Checked

The data collection and analysis process for the first year consisted of each organization sending the Kansas DPCP a hard copy of their Chronic Disease Electronic Management System (CDEMS) summary report. DPCP staff did a rudimentary analysis that included re-keying some of the data into a Microsoft Excel spreadsheet. Because this method of data collection and analysis was very inefficient, each of the participating health care organizations were asked to export the CDEMS summary data into a Microsoft Excel spreadsheet and then submit the file electronically by email to the Kansas DPCP. The data was then merged into a master spreadsheet for analysis.

Impact/Accomplishments:

• The Diabetes CDEMS data analysis* (2005-2008) showed improvements of 50% in almost all clinical process measures:

• Provision of A1C tests improved from 46% to 87%
• Provision of eye exams improved from 19%–43%
• Provision of foot exams improved from 26% to 56%
• Provision of flu vaccinations improved from 18% to 41%
• Provision of Pneumococcal vaccinations improved from 7% to 19%
• Provision of diabetes education improved from 13% to 47%
• Provision of nutrition education improved from 10% to 35%
• Provision of smoking cessation counseling improved from 5% to 17%
• Self-monitoring blood glucose rates improved from 24% to 47%
• Self-management goals set improved from 8% to 26%
• BP checked improved from 36% to 88%
• BMI calculated improved from 9% to 73%

* Data analysis revealed trends. It did not account for patients moving in and out of the registry or not seen during the reporting period.

Challenges/Lessons Learned:

• Utilize a Data Dictionary
• Provide more support to clinics when setting up the project
• Explicit Instructions are needed

Next Steps:

In our commitment to improving chronic illness care in Kansas, a requirement for participation in a Quality Improvement (QI) Project was added to grant requirements in April 2010. Clinics are required to perform one QI project every quarter.

Program Areas:

Heart Disease and Stroke

State Contact Information:

KS
Julie F. Sergeant
Kansas Department of Health and Environment
785-296-5868
jsergeant@kdheks.gov

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