Effects of Quality Improvement Strategies for Type 2 Diabetes in Bronx, N.Y. Laura Boucai, MD, and Joel Zonszein, MD, CDE, FACP, FACE Improving care of people with diabetes has become a major goal for many institutions. This is particularly important in the Bronx because we deal with a large underserved population of ethnic/racial minorities that is susceptible to more diabetes and further complications. Montefore Medical Center already has in place many resources, such as multidisci- plinary diabetes workgroups committed to implementing quality improvement (QI) projects. To carry on such endeavors, a complex and well-designed administra- tive support system is required from the executive offce. The QI committees rely on step-by-step methodologies to defne a series of factors that occur systematically and result in improved care. The large population with diabetes is cared for mainly by primary care physicians (PCPs) that are part of a large sophisticated health care system. Because of both the complexity and diversity of the popula- tion, several programs are tailored to the needs of specifc subgroups. The implementation of different interventions and their effectiveness and cost must be properly assessed. Thus, QI projects are necessary to provide meaningful informa- tion that can be used for improving these health care systems and the patient care they provide. In this article, we describe the population of the Bronx, the structure and programs that are dedicated to diabetes at Montefore, and our information technology (IT) system and how it can be used for QI programs. We also provide an example of how the system is being used. Patient Population in the Bronx Although the Bronx is only one borough in New York City, its population is larger than all but fve U.S. cities. This is a vibrant and younger population of diverse racial/ethnic backgrounds. Data from the U.S. Census Bureau, year 2000, illustrate how the Bronx statistics compare to national statistics. Average population age in the Bronx is 33.27 years versus 36.22 years nationally (71% are < 44 years of age, versus 65.5% nationally). The white population is only 29.9% in the Bronx, versus 75% nationally, with blacks or African Americans composing 35.6% versus 12.3% nationally, and Hispanic or Latinos composing 48.4% versus 12.5% nationally. Albert Einstein College of Medicine is the only medical school in the Bronx, and Montefore is the largest health care provider in the Bronx and its contiguous Westchester County. Montefore is a not-for-proft integrated health care delivery system, a major academic clini- cal center serving patients referred from throughout the New York metropolitan area. It consists of: • 1,060 total acute care beds on two campuses • A network of 19 primary care centers providing 750,000 visits/year • Two specialty ambulatory care centers near Montefore’s hospitals • A 420,000-visit home health agency providing short- and long-term care to home-bound patients • A unifed, enterprise-wide clinical and business information system connect- ing all of the above components • More than 800 house staff members and > 800 full-time academic faculty in all clinical specialties Diverse Programs, Integrated Care Montefore has built one of the nation’s largest, most successful integrated delivery systems, with an extensive network of primary and specialty care. The institution has been accepted to manage fully capitated risk contracts for > 150,000 people. During the past decade, Montefore investments in pro- grams of QI and health IT have gained national recognition for their achieve- ments in patient safety, implementing “best practices,” and improving clinical outcomes. Montefore was among the frst hospitals to establish departments of social services (1914), home health care (1947), and social medicine (1950) and to connect with the community, an essential element in the management of chronic conditions such as diabetes. Because the Bronx is a “hot spot” for diabetes, with a prevalence of close to 12% in the adult population, the institu- tion has established diabetes as a priority disease, making a full commitment to developing resources and a strategic plan to improve the lives of individuals with this disease. The long-term commitment, investment, development of integrated processes, cooperation, and creation of diverse programs that work under one umbrella are already bearing fruit. Following are some examples. The Montefiore Clinical Diabetes Center. Established and certifed by the American Diabetes Association (ADA) for more than 10 years, the diabetes 155 CLINICAL DIABETES • Volume 25, Number 4, 2007 B R I D G E S T O E X C E L L E N C E Downloaded from http://diabetesjournals.org/clinical/article-pdf/25/4/155/321056/155.pdf by guest on 30 March 2023