The NYDC Diabetes Registry Project
In 2003, the Coalition was awarded a three year grant from the New York State Department of Health Diabetes Prevention and Control Program (DPCP) to implement diabetes patient registries in the private practice setting and provide assistance and training to re-organize workflow based on the principles of the Chronic Care Model. Currently, the Coalition is working with several practice sites in Westchester and Sullivan counties. The Diabetes Registry Workgroup conducts an analysis of the information technology needs for participating practices, trains staff, installs software, and provides technical IT support to allow practices to implement a diabetes patient registry. The Coalition also assists the practices to build a diabetes management team and improve patient self-management skills.

The Diabetes Registry Project is modeled after the U.S. Department of Health and Human Services, Health Resources Services Administration, Bureau of Primary Health Care (BPHC) sponsored “Collaborative” to improve care for patients with diabetes seeking care at Federally Qualified Community Health Centers (FQHC). The “Collaborative”, in turn, is patterned after the Institute for Healthcare Improvement Breakthrough Series on diabetes management and draws from the work of Ed Wagner, M.D. on the Chronic Care Model for disease management. The FQHCs that participated in the Collaborative demonstrated an improvement in practice organization and diabetes management through the use of an electronic tool. Two Westchester based health centers, Hudson River Community Health, in Peekskill, NY, and Open Door Family Health Center were participants in the Collaborative; their data suggest that adoption of the Chronic Care Model has improved the health status of their patients with diabetes.

The electronic tool adopted by the Coalition for implementation is called CareFocus. CareFocus was adopted from Qualis Health, the quality improvement organization for the state of Idaho.

To see a sample of screens and reporting capabilities of CareFocus, Click here.

Physician Research and Incentive Programs
In this time of increased health care gaps and disparities, many health related organizations are rewarding physicians who provide high quality care with recognition and, increasingly, financial incentives.

     This area will provide you links to some of those programs:
         American Diabetes Association- Education Recognition Program
         American Diabetes Association
          & National Committee for Quality Assurance Diabetes Physician Recognition Program
         IPRO- Doctors Office Quality (DOQ) Project
         Medicare- Diabetes Project
         MVP Health Plan- Diabetes Recognition and Pay for Performance (pdf)
         Independent Health – Practice Excellence