Christy Holshouser RN BSN, UASON FNP Student

Type II Diabetes Screening

MEDICAL ASSOCIATES OF DAVIE

OWNERSHIP: Novant Health, not-for-profit, integrated healthcaresystem that serves people in Virginia, North Carolina, South Carolina and other regions.

HISTORY: Medical Associates of Davie is a part of Forsyth Medical Group that opened on it’s current location 15 years ago. Today there is also a satellite practice site in Advance, N.C..

PREDOMINANT SOURCE OF REVENUE: Private InsuranceANNUAL NUMBER OF VISITS: Approximately 36,000

(average 3,000 per month)HOURS OF OPERATION:

•Monday to Friday 7:30am-5:30pm•Saturday 8am – 12pm•Sunday 1pm – 5pm

MEDICAL ASSOCIATES OF DAVIEFOCUS: Delivering excellent patient care

MISSION: Novant Health exists to improve the health of our communities one person at a time.

VISION: We, the employees of Novant Health and our physician partners, will deliver the most remarkable patient experience, in every dimension, every time.

PHILOSOPHY OF PRACTICE:COMPASSION: We treat our customers and their families, staff and other healthcare

providers as family members with kindness, patience, empathy and respect.DIVERSITY: We recognize that every person is different, each shaped by unique life

experiences. This enables us to better understand each other and our customers.PERSONAL EXCELLENCE: We strive to grow personally and professionally and

approach each service opportunity with a positive, flexible attitude. Honesty and personal integrity guide all we do.

TEAMWORK: The needs and expectations of any one customer are greater than what one person's service efforts can satisfy. We support each other so that together as a

team, we can be successful in the eye of the customer as a quality service provider.

http://www.novanthealth.org/about_novant_health/company_information.jsp

2009 CENSUS BUREAU•Population: 41,420•Persons <18yrs of age: 23%•Persons >65 yrs of age: 14.9%•Median age: 39•Median income: $52,408•High school graduate: 78%•Disabled persons >5 yrs of age: 6,983•Persons below poverty level: 10.8%•Employed persons: 22,141•# Insured under the age of 65: 27,503•# Uninsured under the age of 65: 7,079•Largest occupational employer: Machine operator,

assembler, and inspector•Largest industry employer: Manufacturing durable goods

DEMOGRAPHICSDAVIE COUNTY – RURAL LAND AREA: 265.18 SQUARE MILES METROPOLITAN AREA: WINSTON SALEM,

N.C.

COMMUNITY RESOURCESFamily Services of Davie CountySocial Services of Davie CountyDavie County Health DepartmentDavie County Senior ServicesPsychiatric services: Daymark RecoveryUnited WayAmerican Red CrossVocational Rehab of Davie CountyStore House for Jesus (Free Clinic provided)Davie County HospitalDavie County Home HealthAutumn Care Nursing HomeDavie Place Residential Care – Assisted LivingPharmacies: CVS, Walgreens,Walmart, Foster’s DrugUrgent Care Facilities: Medical Associates of Davie,

WFUBMC Health Care Center, Davie Primary and Urgent Care

PRIMARY FOCUS: Unidentified population at risk for Type II Diabetes; risk increases with age, obesity and decreased physical activity

SECONDARY FOCUS: HypertensionObesityHyperlipidemiaHyperglycemia

IDENTIFIED COMMUNITY NEEDS

METHODS USED TO ADDRESS NEEDS:Screening for Type II Diabetes

• Fasting plasma blood glucose• Oral glucose tolerance test

Risk Screening Tool (RST) to identify the target population

DIABETIC SCREENING: ADULTS

RECOMMENDATIONS:Testing every 2 years beginning at the age of ten or at puberty if youngerCriteria:

•Overweight >85th percentile for age and sex Weight for height >85th percentileWeight >120% of ideal body weight for height

AND•Two of the following risk factors:

Family history of Type II Diabetes in 1st or 2nd degree relativeRace/Ethnicity (Native American, African American, Hispanic,

Asian, South Pacific Islander)Signs of insulin resistance:

• Acanthosis nigricans• Hypertension• Dyslipidemia• Polycystic Ovary Disease

Acanthosis nigricans

DIABETIC SCREENING:CHILDREN AND ADOLESCENTS

IMPLEMENTED• Educate the medical staff : (Physicians, Practitioners, Nurses, Aides)

In-services with follow-up questionsComputer based training

• Identify the target population:Nursing staff to identify patients who meet weight and blood

pressure criteriaRisk Screening Tool initiated by nursing staff and placed in

patient chart for further assessment during office visitVisual cues placed at nurses station as a reminder of the RST

• Educate the community:Informational brochureCounseling during office visits for patients at risk

SCREENING METHOD IN PRACTICOBJECTIVES • To identify patients at risk

• To increase the rate of appropriate interventions for patients at risk

OUTCOMES • Cost effectiveness of preventative care• Decrease in progression to diabetes• Decrease in microvascular damage

EVALUATED• Audit at one week, one month, and

three months to assess:Percentage of patients who met criteriaPercentage of tools placed on chartPercentage of tools actually used by physician/practitioner

•5-item Lickert scale at one week, one month, and three months to assess:Perception of risk assessment tool

• Ease of use• Perceived value

Process of risk assessment tool

•Audit at one month and three months to assess accuracy rate (number of the identified population that met criteria and were proven,

by diagnostic testing, to have Type II Diabetes)

METHOD IN PRACTICE…

SUSTAINED•Support through governing body of the medical office•Presentation to medical and nursing staff of the results of the audits

and assessments •Implementation into other Novant Health Group offices

NURSE PRACTITIONER ROLE•Physician collaboration•Educate medical and nursing staff regarding research based outcomes

of Type II Diabetic screening•Aid in education of the medical personnel regarding:

Proper technique of BP assessmentProper calculation of BMIIdentification of population at risk

•Adult criteria•Child/Adolescent criteria

METHOD IN PRACTICE…

Center for Medicare & Medicaid Services (CMS). Diabetes screening tests. Washington, DC: CMS; 2005. Retrieved June 12, 2010, from http://www.cms.hhs.gov/DiabetesScreening/

Cooksey C, Allweiss P, Campbell KP. Diabetes evidence-statement: screening. In: Campbell KP, Lanza A, Dixon R,Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser's Guide to Clinical Preventive Services: Moving Science intoCoverage. Washington, DC: National Business Group on Health; 2006. Retrieved June 12, 2010, from http://www.businessgrouphealth.org/preventive/topics/diabetes.cfm

Feig DS, Palda VA, Lipscombe L. Screening for type 2 diabetes mellitus to prevent vascular complications: updated recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2005 Jan 18; 172(2): 177-80 [44references]. Retrieved June 10, 2010, from PubMed.

Kahn, R., Alperin, P., Eddy, D., Borch-Johnsen, K., Buse, J., Feigelman, J. et al. (2010, April 17). Age at initiation and frequencyof screening to detect type 2 diabetes: A cost effectiveness analysis. The Lancet, 375(9723), 1365-1374. Retrieved June 10, 2010 from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62162-0/abstract#aff1

Norris SL, Kansagara D, Bougatsos C, Nygren P. Screening for Type 2 Diabetes: Update of 2003 Systematic Evidence Reviewfor the U.S. Preventive Services Task Force. Evidence Synthesis No. 61. AHRQ Publication No. 08-05116-EF-1. Rockville, Maryland: Agency for Healthcare Research and Quality. June 2008. Retrieved June 12, 2010, from http://www.ahrq.gov/clinic/uspstf08/type2/type2art.htm

Rutten, G. (2010, April 17). Screening for type 2 diabetes - where are we now? The Lancet, 375(9723), 1324-1326.Retrieved June 10, 2010, from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)62162-0/abstract#aff1

REFERENCES