Diabetes Outcomes

Through the practice incentive program the government seeks to reward practices for meeting defined outcome measures. One of these outcomes is completing ‘cycles of care’ for patients who have a diagnosis of diabetes.

Intervention for diabetes (such as reduction of blood pressure, sugar levels or cholesterol to recommended targets) result in up to 20% reduction of heart attacks over five years. Reminders to complete the ‘cycle of care’ could help promote additional beneficial interventions among patients with diabetes.

Incentive payments

Current practice diabetic patient population at Kensington site : 256 (according to early 2018 PIP data) Annual outcome payment : $20 per diabetic patient = $5120. : has been achieved in recent years, but not in the most recent quarter.

Current Diabetes SIP claiming rate (according to late 2018 PIP data) = 49%

Target Diabetes SIP claim rate to claim annual outcome payement = 50%
target has been achieved in recent years, but fell below 50% in the most recent quarter

Additional Diabetes SIP revenue, if target Diabetes SIP claim rate achieved = (50-49)/100 * 256 * $40 = $100

Additional revenue if Diabetes Outcome Payment achieved = $5120 (annual outcome payment) + $100 (additional diabetes SIP revenue) = $5220

Tasks required to improve detection of patients who might benefit from diabetes review

In order to improve the care of patients with diabetes, it is necessary to identify patients who have diabetes. This is in part achieved by ensuring that patients with a diagnosis of diabetes in the past history have a coded diagnosis of diabetes in the file.

This is because if the diagnosis is not coded then automated techniques to identify patients with diabetes does not work well.

Work has already been done to convert ‘non-coded’ diagnosis of diabetes into coded diagnoses.

The Best Practice clinical software does not recognize diabetes diagnoses of the type ‘non-insulin dependent’ or ‘insulin dependent’ diabetes or the variations of that style of diagnosis naming (e.g. ‘NIDDM’ and ‘IDDM’).

The following SQL code helps identify those patients in the file with the ‘NIDDM/IDDM’ style of diabetes diagnosis recorded in file, without any other diagnosis which is recognized by Best Practice as ‘diabetes’.


SELECT *

FROM BPS_Patients
  WHERE StatusText = 'Active'
  AND (InternalID IN (SELECT InternalID FROM PastHistory WHERE ItemText LIKE '%iddm%')
  OR InternalID IN (SELECT InternalID FROM PastHistory WHERE ItemText LIKE '%diabetes%')
)

AND InternalID NOT IN (SELECT InternalID
  FROM PastHistory
    WHERE ItemCode IN (3, 775, 776, 778, 774, 780, 1563, 7840, 11998)
    AND RecordStatus = 1)

AND InternalID NOT IN (SELECT InternalID
  FROM PastHistory
    WHERE Itemtext LIKE '%pre diabetes%'
    AND RecordStatus = 1)

AND InternalID NOT IN (SELECT InternalID
  FROM PastHistory
    WHERE Itemtext LIKE '%prediabetes%'
    AND RecordStatus = 1)

ORDER BY surname, firstname

This search identified 128 patients across coHealth with ‘iddm’ or ‘diabetes’ in a recorded diagnosis, but not identified as diabetic by Best Practice. Of these, twenty-four (24) had a ‘iddm’/‘niddm’ style diagnosis.

It is proposed that the ‘iddm’/‘niddm’ diagnoses be converted to a form recognized by Best Practice. ‘NIDDM/non-insulin dependent diabetes mellitus’ can be converted to “Diabetes Mellitus, Type 2”. ‘IDDM’ has direct equivalent in Best Practice, it can be converted to simply “Diabetes Mellitus”.

Identifying patient with a diagnosis of diabetes, but incomplete cycle-of-care

About 50% of patients seen at the clinic every day ‘leave’ without having a completed cycle of care. Of course, there are many reasons why this might the case. Completing a cycle of care takes time, and also takes patient motivation to complete some elements of care.

In other cases, the cycle of compare might be complete, or be almost complete, but the attending health provider might not be aware that the cycle is close to completion.

In another project at Kensington site, patients were identified every day for a period of six weeks, who were already booked to be seen that day. Clinicians were notified that a preventative action could be done. During the intervention period, immunization rates for Zostavax improved in absolute terms by 8.9%, a 17% relative increase in Zostavax immunization in the target population.

It is proposed that diabetic patients who have not had diabetes SIP claimed be identified daily, and clinicians notified.

Best Practice SQL code to identify diabetic patients without a Diabetes SIP claim in the past year

SELECT *
FROM BPS_Patients

WHERE StatusText = 'Active'

AND InternalID IN (SELECT InternalID 
    FROM Appointments
    INNER JOIN (VALUES('%bhagwat%'),('%fong%'),('%ekanayake%'),('%shoesmith%'), 
            ('%plastow%'),('%samarawickrama%'),('%obeyesekere%'),('%chaves%'),
            ('%ryan%'),('%mikhail%'),('%haynes%'),('%buckwell%'),('%maxwell%'),
            ('%grace ho%'),('%bullen%'),('%lambrou%'),('%zeigler%')) AS providers(Name)
    ON dbo.BPSPayee(UserID) LIKE providers.Name

    WHERE AppointmentDate = '20190318'
    AND RecordStatus = 1
    )
    
AND InternalID IN (SELECT InternalID
    -- history of diabetes
    FROM PastHistory
        WHERE ItemCode IN (3, 775, 776, 778, 774, 7840, 11998)
        AND RecordStatus = 1)

AND InternalID NOT IN (SELECT InternalID
    -- DiabetesSIP claimed in past year
    FROM Invoices WHERE InvoiceID IN (SELECT InvoiceID 
        FROM Services WHERE Recordstatus = 1 
            AND Mbsitem IN (2517, 2521, 2525) 
            AND Servicedate BETWEEN DATEADD(Year, -1, GetDate()) AND GetDate()))
            
ORDER BY surname, firstname