*No target benchmark *Please note: no 2017 data available

Reducing A1c blood level results by 1 percentage point (eg, from 8.0 percent to 7.0 percent) helps reduce the risk of microvascular complications (eye, kidney and nerve diseases) by as much as 40 percent. Lowering A1C to approximately 7% or less has been shown to reduce microvascular complications of diabetes, and, if implemented soon after the diagnosis of diabetes, it is associated with long-term reduction in macrovascular disease. Therefore, a reasonable A1C goal for many nonpregnant adults is 7%. Providers might reasonably suggest more stringent A1C goals (such as 6.5%) for selected individual patients if this can be achieved without significant hypoglycemia or other adverse effects of treatment. Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease (CVD). Less stringent A1C goals (such as 8%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the general goal is difficult to attain despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin.⁷ 

Source:

⁷Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c (HbA1c) Poor Control (9%) – National Quality Strategy Domain: Effective Clinical Care. (n.d.). Retrieved May, 2019, from https://qpp.cms.gov/docs/QPP_quality_measure_specifications/Claims-Registry-Measures/2017_Measure_001_Claims.pdf

The ACT Collaborative consists of the ACT Planning Team and Partners.  The planning team is a group of ADH Internal partners and External partners that meet regularly to plan learning sessions/webinars, provide monthly monitoring, provide decisions/implement policy changes of interventions as needed. 

ACT External partners include: Arkansas Foundation for Medical Care (AR QIO), Arkansas Geriatric Education Center at UAMS, UAMS Department of Family & Preventive Medicine, CME Division, Community Health Centers of Arkansas, Inc. (CHCA), and Walker Family Clinic. 

*MIPS Quality Benchmarks (Registry/Quality Clinical Data Registry)

*NQF: National Quality Forum

*Quality ID: Merit-Based Incentive Payment System (MIPS) Quality ID

Evaluation results show patients with chronic diseases in ACT practices benefitted from clinic changes and team-based approaches to patient care utilizing CCM components. The ADH ACT team and QI consultant worked with ACT participating clinic teams to apply different strategies to improve the quality of care being delivered to patients. Some clinics were more proactive than others in their approaches to team-based patient care.

The partnerships between the ACT Collaborative Committee, QI Consultant and ACT participating clinics are great facilitators for quality improvement (QI) within primary care settings that cater to patients with cardiovascular disease (CVD), hypertension, and diabetes mellitus. As a result of these partnerships, participating clinics learned and significantly improved the quality and delivery of primary care for their patients. These relationships prove to be long-lasting for several providers for future networking with the ADH, ACT Collaborative Committee members and with each other.

The ADH awarded mini-grants using 1305 funds to participating clinics to cover for their out-of-clinic training time during ACT QI Quarterly training sessions. These mini-grants proved invaluable to clinic staff and enabled them to receive and actively participate in ACT meetings, calls, data collection and sharing. Once data access was enabled for ACT clinics, particularly by working with the QIO, they enjoyed being able to review their monthly data pulls from their EMRs and discuss their progress with the ACT Committee. Barriers were documented for EMR capabilities and clinic staff capacities.

ACT clinics have different EMR systems; some are sophisticated, while others are very basic systems. Although the clinics capacities to extract EMR data vary, by December 2014, all the clinics were able to modify their EMRs to extract reasonable information. Primary healthcare teams vary in capacity and some ACT clinics have fewer healthcare personnel than others, which makes it hard to manage clinic flows and improve the quality of care for patients. Participating in the ACT Collaborative helped these practices make significant changes in their settings, improve patient care and follow up, and provide evidence of change through better data and patient outcomes. 

PDSA cycles and EMR modifications were the cornerstones to maximize the length and quality of life for patients with diabetes, hypertension, and intravascular disease, satisfy patient and caregiver needs, and maintain or decrease the cost of care. This was achieved by implementing systems-based changes and applying the evidence-based model of care that focuses on improving interactions between patients and providers. These clinic teams used very innovative approaches to increase the percentage of patients receiving appropriate care.

Continuing approaches to improve patient care include: multiple PDSAs, linkages with specialists and laboratories to facilitate timely return of reports, advocating for patient self-management of their disease conditions, integration of planned care and effective case management, assurance of continuity of patient care through measurable goals and EMR triggers and phone calls for client reminders, patient risk stratification through use of standard guidelines, and identification of high-risk patient populations for aggressive care. 

A focus for future improvements in data collection and performance monitoring will be EMR upgrades by specific vendors