Challenge:

The SHAPE project consists of project management, technical assistance around workflow redesign and quality improvement services to achieve an end result of improving hypertension and diabetes awareness and management among patient populations in CT health care organizations. The SHAPE project activities are focused on implementing programs to prevent and control chronic diseases and their risk factors to FQHCs, primary care offices, and community support services.

Solution:

Qualidigm focuses on the quality improvement aspect of understanding the organizations process and then refining via process mapping and workflows. Our engagement with the participating Federally Qualified Health Centers (FQHCs) and primary care offices are providing education on: care coordination, using data for quality reporting, identification of high risk patients and criteria, including PCMH sustainability. Qualidigm also developed and implemented a learning collaborative for the FQHC and primary care office participants. The learning collaboratives Qualidigm provides are in-person events, webinars, group sharing calls, and technical assistance visits to address diabetes and hypertension workflow processes. After Qualidigm completes the technical assistance, including learning collaboratives, we create and give the FQHCs and primary care offices a finalize packet of workflows, policies, best practices, opportunities for improvement and community resources list as a reference and to utilize for new employees.

Benefit:

The participants that we have worked with implementation of quality improvement protocols for improving hypertension and diabetes quality measures which include a workflow redesign and office policies. We influence their diabetes management resources and introduce community resources including Diabetes Self-Management Education (DSME) for their location. Lastly, we assist practices identify staff members that can step in to focus on closing any gaps and/or referral loops.