Improving Diabetes Care and Outcomes on the South Side of Chicago

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Primary Care Group

Team pictured from left to right: Monica Peek, Joanne Ivory, Lynda Hale, Virginia Brumby, Deb White, Lisa Vinci, Jenn Clark


Project Team

Provider Champion: Lisa Vinci MD, Medical Director
Provider Champion: Jennifer Clark, NP, Diabetes Care Manager
Front Office Champion: Virginia Brumby, Clinic Coordinator
Front Office Champion: Kimberly Banks, Clinic Coordinator
Back Office Champion: Joanne Ivory, RN, Clinical Nurse Supervisor
Back Office Champion: Debra White, Administrative Manager
Administrative Champion: Lynda Hale, Administrative Director
Other Team Members:  Andy Davis, MD; Emily Lu, Medical Student

 

The Primary Care Group team has undertaken several diabetes quality improvement projects.  To provide feedback to providers on how well their patients with diabetes are doing, data from a new electronic medical record system (EMR) and billing data have been combined to create “diabetes rosters” (diabetes panel reports).  How best to use the rosters to improve care delivery is still being explored.  Staff retraining and EMR integration have boosted the number of patient referrals made by providers to nutrition and diabetes counseling.

One team member, Jenn Clark, created a “resource room” to allow for better access to important information and tools for both patients and providers, including diabetes start-up kits (educational materials, equipment, etc.).  Other interests include providing patient navigation services to help patients keep track of appointments and perhaps utilizing cell phone text-message technology to support patient diabetes self-management.

Provider Workshops were piloted with Primary Care Group Providers.

Jenn Clark has helped to co-teach patient Diabetes Empowerment Classes with Donna Prost from the Kovler Diabetes Center team.

 

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