Electronic Patient Registry Helps Improve Outcomes for Diabetic Patients Served in New York City Public Hospitals and Health Centers
May 14, 2009
The New York City Health and Hospitals Corporation (HHC) today announced a significant increase in the number of diabetic patients who have achieved healthy levels of blood sugar, blood pressure and cholesterol — the three leading indicators for the disease.
HHC attributes the improved health outcomes to an aggressive chronic disease management program and the use of a computer-based patient registry. The registry pulls data from HHC’s advanced electronic health records system and allows clinical teams to tailor medication regimens and better support self-management efforts for more than 50,000 New Yorkers with diabetes.
The new 2008 rates were posted today on the HHC In Focus section of the website, www.nychhc.org/hhc, as part of HHC’s transparency initiative to voluntarily share information on hospital quality of care and safety with the public.
“As early adopters of electronic health records, we have been able to harness the power of this technology to enable the more effective management of chronic diseases like diabetes. Our progress to date demonstrates that the effective implementation of health information technology can reach beyond the obvious advantages of a paperless system and help reduce long-term healthcare costs that are disproportionately driven by poorly-managed chronic disease,” said HHC President Alan D. Aviles.
In 2008, 45.5% of all adult diabetic patients under routine care at HHC facilities achieved a healthy blood sugar level, as reflected by a Hemoglobin A1c test result of less than 7. This means that nearly 21,000 patients had well-controlled blood sugar levels – almost 5,000 more patients compared to 2007 when only 42.6% reached healthy A1c levels. More than 20,000 patients – just over 40% — met the healthy blood pressure goal of 130/80 compared to the 37.6% the year before. Almost 27,000 patients — nearly 55% — registered healthy cholesterol levels, measured by LDL levels under 100 mg, compared to 53.8 % the year before.
HHC has more than 50,000 diabetic patients registered in its electronic database. With the use of comprehensive patient data harnessed from the electronic health records, clinical teams can closely monitor each patient, give more targeted, evidence-based treatment, and identify patients who need more support in their self management efforts. The registry provides a real-time “snapshot” of each diabetic patient’s health status, automatically alerts doctors to ensure patients receive annual foot and eye exams, and allows physicians to compare their patients’ results to other HHC doctors with similar groups of patients.
Diabetes is a chronic disease that affects nearly 24 million Americans and is the leading cause of kidney failure, adult blindness and lower extremity amputation, and is also a prime contributor to heart disease and stroke. According to the City Department of Health, approximately 500,000 New York City adults have been diagnosed with diabetes while an estimated 200,000 more have the condition but do not know it. Overall, the percentage of New Yorkers with diabetes has more than doubled over the past ten years, and roughly 8 percent of all New Yorkers now have the disease.
Although comparative data is limited, the New York State Department of Health and the National Committee for Quality publish diabetic patient data for state and national Managed Care plans. HHC diabetic patient outcomes consistently outperform both state and national averages reported for the managed care plan patients. Below are highlights of the data from the HHC in Focus web pages.
Diabetic Patients with A1C < 7
Diabetic Patients with Blood Pressure Under Control
Diabetic Patients with Cholesterol Under Control
* Statewide average of all New York Medicaid Managed Care plans; Source: NYS Department of Health
** National average of all Medicaid Managed Care plans; Source: National Committee for Quality Assurance
To evaluate the effectiveness of its diabetes care, HHC regularly tests and tracks the blood sugar, blood pressure and cholesterol level of all its diabetic patients. Controlling cholesterol levels and blood pressure is crucial to preventing cardiovascular problems, including heart attacks and heart disease, which are high-risk conditions for diabetics.
HHC also teaches patients self-management skills to keep their illness under control, including the importance of testing their blood sugar, and the need for exercise, proper diet and weight control. Since HHC patients are so culturally diverse, its facilities have developed expertise in teaching patients how to make healthy food choices and how to prepare healthier meals within the dietary customs of their own communities.
HHC’s innovative diabetes programs include Diabetes Management/Chronic Disease teams, Certified Diabetes Educators, as well as:
- Patient Outreach with Education and Reinforcement (POWER) program — to recruit and train volunteers to teach self-management and health literacy skills to diabetic patients at Lincoln Hospital Center.
- WeCOACH (Community Older Adults Care About their Health) program — for older adults with uncontrolled diabetes who are paired with a Peer Coach to support them through a 6-week exercise and wellness program. Lincoln, Jacobi, North Central Bronx, Metropolitan, Queens and Woodhull are piloting the program.
- House Calls — a tele-monitoring program for patients with uncontrolled diabetes who use a glucometer the size of a flip phone, a blood pressure cuff, and a modem to transmit daily data by telephone to a care team on the other end who regularly monitor blood sugar levels and share instant feedback and give advice to the patients.
Contact: Ian Michaels (HHC) .