ELEGANT-DM2
Last updated
Share PrintHas your facility struggled to meet diabetes related matrices? Do Veterans with diabetes and providers caring for them feel overwhelmed managing the expansive field of diabetes therapeutics? Has an access to endocrinology services been a barrier in advancing care for Vets with diabetes? If your answer to any of these questions is yes, then let's connect! Our approach, ELEGANT-DM2 is an innovative and collaborative approach to address each of these issues. It uses virtual modalities for collaboration and dashboard tools to provide proactive care addressing each of these barriers.
Origin:
September 2020, Pittsburgh VA Medical Center-University Drive
Adoptions:
7 successful
Awards and Recognition:
Office of Health Equity Quality Initiative funding
Partners:
Clinical Pharmacy Practice Office, Diabetes and Endocrinology, Health Equity, Office of Primary Care
Recent Updates
Overview
The problem
Images
Above:
A quick look at the burden of diabetes within the VA.
Files
- VHA wide Diabetes data burden as of 09/05/2023 extracted from corporate data warehouse Diabetes Data Burden_2023.pdf
The solution
Images
Above:
Patient Centric ELEGANT-DM2 approach
Above:
The ELEGANT-DM2 workflow process .
Files
- A process cycle showing system redesign of the patient centric care using various tools for collaboration. Structure of the ELEGANT solution
The results
Images
Above:
The A1c results before the intervention and after the intervention for all Veteran seen during the pilot stage.
Above:
The A1c results before the intervention and after the interventions for those defined as poorly controlled.
Above:
A secondary measure shows improvement of the prescriptive rates of SGLT2i and GLP1-RA in applicable patients.
Files
- A file showing outcome data from ELEGANT-DM2 pilot. Results Summary 1
Metrics
- HbA1c Improvement
- Reduced gap in the care for rural Veterans reflected by DM23h_ec matrix
- Increased prescription rate of concentrated insulins by clinical pharmacist practitioners
- Increased prescription rate of continuous glucose monitors by clinical pharmacist practitioners
- Improved rate of the prescription of new glucose lowering agents in patients with CHF, CKD, and cardiovascular diseases
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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Phase one: 0-3 months
Diabetes focused population needs assessment:• Train the nurse care manager (NCM)/program support analyst (PSA) to use primary care equity dashboard (PCED), academic detailing diabetes dashboard (ADDD), and corporate data warehouse (CDW).• Use the PCED and CDW to identify the gaps in the care.• Using the tools, NCM and PSA identify the sites and the resources at the sites in need:• Availability of CPP, CPT, medical support assistant (MSA), and endocrinologist.• CPPs to review training, competency requirements, and scopes of practice. -
Phase two: 6 weeks to 3 months (in tandem with later half of phase one)
Planning phase:• Review the established grids for CPPs and endocrinologist.• Identify CPP leads and champions in the system.• Collaboration planning meetings between home telehealth (HT), CPP, NCM, CPT and endocrinologists.• Assess or redesign the calendar for collaborative processes.• Work with CPRS support team to create CPRS tools: templates, clinic locations, encounters, and parent-child notes for workload capture.• Set the go-live date.• Education and information materials to be sent out to all primary care providers, such as email communication and chief’s weekly newsletter. -
Phase three: 3rd month and continuing
Implementation phase• CPPs/CPTs start engaging with Vets who are identified in need of care collaboration.• MSAs/licensed practical nurse (LPN) if available, start with scheduling process.• CPTs complete the scripted intakes for CPP.• CPPs schedule patients in the clinics (any).• Weekly huddles start a week after go-live date.• CPPs start implementing the action plan for individual Veterans. Care collaboration continues guided by patients' needs. -
Phase four: 6 months from the go-live date
Program assessment: 3 months after phase 3 implementation (6 months from the go-live date)• Reassess eQM matrices for A1c for each provider.• Reassess eQM matrices for A1c each sites.• Each FY-Q reassess delta in the PCED data from baseline.• Conduct the surveys, if interested, from Veterans, PCP, and CPP about the process.• Cost saving can be extrapolated for CPP and Endocrinologist using existing formulae. -
Phase five: 9 months from the go live date
Program expansion:• Care expansion to include Diabetes technology. Includes training, software and hardware procurement.• Consider creating CVT/VVC clinics for Endocrinologist, if not already in existent.• Consider revising scopes for prescription practices, if already not done.• Consider expanding to all PACT teams, if not already established.
Departments
- Pharmacy
- Endocrinology
- Administration
Core Resources
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Optional Resources
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Support Resources
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Risks and mitigations
Risk | Mitigation |
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Risks during assessment phase | A well coordinated effort is needed to identify and design a collaborative program. Risk of excess burden may arise from non-engagement or lack of a NCM or program manager to assist with this step. Mitigation measures may include reserving time for the lead clinical pharmacist/s and /or endocrinologist providing support and oversight for the program. |
Larger than expected burden of care |
While the state of the diabetes care at their specific sites may already be well known to the sharks, actual burden of care may be out of proportion based on the resources available, namely clinical providers: PCPs and CPPs. Mitigation measures: A realignment of case load, a review of current panels and bookability for CPPs may need to be revisited to improve the care quality provided by the PACT teams. |
Non-availability of Endocrinologist/Endocrine Service |
Lack of endocrinologist to engage in the care collaboration or lack of available time when endocrine services do exist. Given that Endocrinologists actually provide the backbone for complicated care in this program, the program will not be successful to its fullest. Mitigation: VA Pittsburgh HCS/VISN4 will be willing to provide clinical support/program oversight to the site in need. Under well specified MOUs, VAPHS may provide an interim endocrine support, while the facility considers either future hiring or developing a long term relation with VAPHS/VISN4 based programs. |
Contact
Comment
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Email archana.bandi@va.gov with questions about this innovation.
About
Origin story
Original team
Archana Bandi, MD
Endocrinologist responsible for the oversight
Amy Plumley, PharmD, BCACP, CDCE
PACT Clinical Pharmacy Supervisor
Jessica Anderson, PharmD
Clinical Pharmacist Practitioner
Danya Becker, PharmD
Clinical Pharmacist Practitioner
Stephanie Sodders, PharmD, BCPS
Clinical Pharmacist Practitioner
Amazing work again by VAPHS highlighting the power of teamwork to improve the health of veterans some of which are in rural locations!
I am PACT CPP at VA Pittsburgh and I have had the pleasure to work with Dr. Bandi and my CPP colleagues in our Endocrine-PharmD Collaboration Group. I completed my PGY1 in 2022 and began working in the PACT setting immediately after. The Endocrine-PharmD meetings have been a major benefit for me at VAPHS, especially in my first year as a PACT PharmD. I have brought many difficult and/or interesting cases to our meetings and always leave with a great plan. I have learned a lot from our meetings by discussing cases and reviewing literature/guideline resources. It is great to know that when I am facing a difficult to manage case, I can bring the patients needs to the group to collaborate on an effective and safe plan.
- Albert Allard, PharmD