Diabetes Patient Registry Pilot Project
In 2003, the Coalition was awarded a grant from the New York State
Department of Health Diabetes Prevention and Control Program (DPCP) to implement a diabetes patient registry in private practice settings and provide assistance and training to re-organize workflow based on the principles of the Chronic Care Model. The NYDC has implemented this project at private practices in Westchester and Sullivan counties. Components of the project include an analysis of the information technology (IT) needs for participating practices, staff training, software installation, and IT support to implement a diabetes patient registry, as well as assistance to build a diabetes management team and improve patient self-management skills.
The Diabetes Registry Project is mirrored 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 a significant improvement in practice organization and diabetes management through the use of a registry. Two Westchester based health centers, Hudson River Community Health, 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. |
