A. O’tayo Lalude, MD
Dr. A. O'tayo Lalude discusses how Bridges to Excellences stimulates increased physician efficiency and produces effective outcomes in the quality of life for patients with diabetes:
“The challenges for the primary care physician to overcome are: to master the ADA standard of care guidelines; to develop an auditable metrics translation suitable for the practice; to systematize interventions with transparent paper (or electronic) process of “default-to-action”; and to periodically review performance measures (internal auditing) of practice case mix (the population).”
The Practice: A. O’tayo Lalude, MD @ 2500 West Market Street, Louisville, Kentucky 40212-1541. Telephone: 502-778-8400
The Program: Diabetes Care Link
The Motive: Receiving inadequate marks, in the care of my patients with chronic disease like diabetes, on retrospective Quality Reports from the patients’ insurance companies forced me to ask myself the questions: What is a Quality Report? How do they collect the data? What are the reference points for the data? Why is the intrusion necessary since I am already providing quality care to my patients?
The Challenge: My challenge was “to prove the system wrong” since I was practicing a “standard of care (SOC)” medicine. Every one of my patients was doing well according to the ability of care I gave them. How can I get into a clinical peer review to validate my efforts? My challenge was met by ADA guidelines, awareness of IOM reports, NCQA continued measurement of healthcare quality, and BTE consortium rewards for physician evidence-based medicine (EBM) for good outcomes in quality of life improvement (QOLi) for all my diabetes patients.
The Process: Redesigned progress note that is a directional and processional “dashboard” that would be used at every office visit by the patient. Vital signs; BMI; all active medicines used; reports of A1c, glucose, lipids, micoalbuminuria, and other lab. tests; immunizations for flu, pneumonia, tetanus, and hepatitis; and referral notation columns for Ophthalmology, Podiatry, etc. are formatted on the same page for a “Default-to-Action” performance metrics.
The Benefits: Outstanding. The practice has successfully engaged in system translation to accomplish Diabetes excellence. The old paradigm of SOC for an individual patient was expanded into a population of diabetes patients wellness using EBM criteria for practice standard with outcome reports consistently over 85 to 94% in the metrics.
The Results: Again outstanding with the ADA/NCQA Diabetes Physician Recognition and participation in the Diabetes Care Link program – a process of physician re-education for effectiveness and efficiency and for reductions of complications from diabetes vis-à-vis tremendous savings in healthcare costs.