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Quality Improvement

QI Collaboration- Activities toward creating a more robust infrastructure to support performance improvement in the rural community clinics are underway between the three participating consortia.  Specifically, we are working together to track diabetes and coordinate a learning community to share our work. A stronger level of collaboration among the rural partners and communication is being built as a result of this project. Information exchange during the Project Management Team monthly meetings has helped increase awareness in the uniqueness of each of the three service territories and their network structures. All three are rural but yet still very different.
 
Based on the relationships and increased collaboration we build through this work, we have begun to explore each others’ network infrastructure, QI groups and some of the work being done at the consortia more closely. Moving forward, creating a more cohesive QI regional collaboration model will require ongoing extended outreach to each other by all three participating organizations.

Tracking Diabetes- ARCH, HANC and NCCN have been working with their members to track the following indicators for diabetes:

• % of Diabetic Patients in a Registry
• % of Diabetic Patients Tested for HbA1c
• % of Patients with HbA1c <7
• % of Diabetic Patients with HbA1c between 7-9
• % of Diabetic Patients with HbA1c >9
• % of Diabetic Patients with LDL Screening
• % of Diabetic Patients with LDL <100

Our collaborative has aggregated diabetic patient data for the region.

Results- In the 13 county  region, there are a total of 37 clinic sites that are tracking these specific diabetic indicators for 100% of patients tracked using a disease registry.  In August 2011, the consortia collected the data represented graphically below for the period of July 2010 through June, 2011.
 
The consortia have seen the positive impact of their collaborative quality improvement efforts as the frequency of HbA1c testing has increased. Through the examination of data, the networks identified barriers and responded to clinic member needs, assisting with the availability of on-site HbA1c testing, staff and administration training on QI basics and registry use, and enhanced data validation technical assistance. However, beyond the clinic walls, the consortia face continued challenges due to economic and geographic factors. For the populations with HbA1c over 9, it is felt that due to the challenging economy, our patients are unable to afford to test on a regular basis and purchase the medications needed to maintain proper glycemic control. Additionally, many rural communities lack recreation departments thereby making regular exercise challenging, especially during the winter months. Fresh produce is also limited, further challenging a proper diet.
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