major factors for success has been getting physicians involved in the quality improvement process and making them responsible for collecting their data in a prospective manner. By asking them to track their patient interventions, physicians were not only assessing their results but also responding to them at the time of encounter. It was also critical to give physicians data on their population of patients and tools to facilitate patient management, according to Drs. Solano and Siminerio.

Physicians received quarterly reports on the laboratory data pertinent to the care of their diabetes patients. Laboratory results along with patient demographics, visits and charges were captured into a large UPMC clinical data repository called Medical Archival Retrieval System (MARS).

The initiative began as a voluntary participation project; but physician participation eventually was mandated. At the start of the initiative approximately 120-130 physicians (50 to 60 percent) participated in tracking and reporting data based on the project guidelines, by the end of the study period 95 percent participated.

In addition, diabetes educators were hired to provide diabetes education at physician practices on "diabetes days," in order to maximize efficiency with the added benefit of the focused visits for the practice. Education was promoted through the practices and public awareness campaigns.

"Diabetes care is becoming a priority for health systems as costs and health outcomes are being closely scrutinized. Because the traditional health care system is designed to provide a symptom-driven response to acute illnesses, it is poorly configured to meet the needs of the chronically ill," said Dr. Siminerio. "Although it may take years to see significant impacts on micro- and macro-vascular disease, our results would lead us to believe our patients have been best served by these ongoing quality efforts."

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Contact: Frank Raczkiewicz
RaczkiewiczFA@upmc.edu
412-647-3555
University of Pittsburgh Medical Center
6-Apr-2004

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