NEW REPORT SUGGESTS WAYS FOR ELECTRONIC DISEASE REGISTRIES
TO IMPROVE DIABETES CARE

FOR IMMEDIATE RELEASE   
July 28, 2006
(Tarrytown, NY)…Disease-specific electronic registries are powerful tools that give health care professionals the knowledge to improve their care of patients living with chronic diseases such as diabetes, and can motivate individuals to take better care of themselves, according to a report published today by the Hudson Center for Health Equity & Quality (Hcheq). However, the report notes that physicians in community settings will have difficulty installing such systems without financial assistance and ongoing technical support. The report is based on a Diabetes Registries Roundtable held at Hcheq's offices in Tarrytown, NY, on Nov. 16, 2005.  Disease registries are computerized databases that sort patients by level of risk and generate lists of patients needing care.

 "As far as we know, the Hcheq Diabetes Registries Roundtable was the first organized discussion of the problems faced by small, resource-strapped independent practices in adopting chronic disease registries," says Georganne Chapin, President and Founder of Hcheq.  "It is clear from the proceedings that enormous benefits can accrue from the adoption of a diabetes registry, but we're still searching for answers to the big questions, such as how are we going to compensate physicians for the time and expense it takes to get a registry up and running, and how can we motivate medical offices to radically transform their work flow?"

The Hcheq Roundtable brought together several diabetes registry pioneers, including four who've established registries in California, Vermont, North Carolina, and New York. They shared their experiences and knowledge with local health professionals. 

Diabetes - a serious and growing problem
Since 2002, the number of people with diabetes in the United States has grown alarmingly from 6.3 percent to 7 percent of the total population. Diabetes is now the nation's sixth leading cause of death, according the National Centers for Disease Control. Diabetes can be managed, but it takes a coordinated effort among the primary care physician, the patient, multiple specialists, and diabetes educators to ensure that the patient is examined and tested in a timely fashion, particularly if the patient is lax about making and keeping appointments for examinations.  "The challenge for physicians is to ensure that they are successfully monitoring the health status of all of their patients with diabetes, not just the compliant ones," Ms. Chapin says.

 "Physicians and their health-care teams need to be able to identify their patients who have diabetes and to have all lab values and notes readily available, otherwise they can't provide the care their patients need when they need it," explains Janet (Jessie) Sullivan, MD, Chief Medical Officer of Hudson Health Plan in Tarrytown, NY, who discussed her plan's experiences with registries. "Health professionals need to see how well they're doing in managing all their patients with diabetes, so they can determine where there is room for improvement. A registry can help you do all that."

Registries allow practices to look at the populations they care for, find high-risk sub-populations who need extra care or follow-up and go after them proactively. "That's the most powerful part," says another roundtable presenter, W. Cyrus Jordan, MD, MPH, Medical Director of the Vermont Program for Quality Health Care in Montpelier, VT. 

Making the business case for registries
Roundtable participants reported that registries have dramatically improved the health status of their diabetes patients. Alan Glaseroff, MD, Chief Medical Officer of Humboldt-Del Norte Foundation, Eureka CA, who led the development of the Humboldt Diabetes Project for the Humboldt-Del Norte Independent Physician Association (IPA), said the registry increased the percentage of patients receiving nephropathy or kidney function assessments from 42 percent to 70 percent in one year. The proportion of patients whose diabetes was poorly controlled, as measured by HbA1c blood hemoglobin levels of 9 percent or higher, fell from 7.7 percent to 6.9 percent.

Still, despite ample evidence that a registry can lower medical costs by improving diabetes management, the savings generally flow to insurers and employers, according to the Hcheq report. Registry software may be free or low-cost, but upfront hardware installation and training costs may be large. Data entry can add hours of work to an office staff already stretched thin. "If doctors do not get a fair share of the financial rewards, it will be tough to get them to take on the work and expense required to implement registries," the report warns.

Roundtable participants suggested some models for funding patient registries. At NorthEast Medical Center in Concord, NC, the registry is supported by a community hospital, which manages and financially supports the system for private doctors. At Humboldt-Del Norte IPA, physicians pay registry expenses but recoup some of the cost through pay-for-performance incentives paid by insurers, which rewards practices for conducting tests and exams on a timely basis.

The report concludes that pay-for-performance could make registries financially viable. Large medical practices that use patient registries to improve the quality of their care can earn tens of thousands of dollars in bonuses annually. "Pay-for-performance seems a promising vehicle for ensuring that practices not only don't lose money when implementing a registry, but actually have a chance to reap some financial reward from the effort," Dr. Sullivan says.

The four roundtable presenters were:

Douglas G. Kelling, Jr., MD, of Concord Internal & Pulmonary Medicine, Concord, NC, who led the development of a community-based diabetes management system. The registry, in use since 1995, covers 7,000 patients with diabetes. The registry, now expanded to include other chronic diseases, is accessed by 62 physicians practicing in 13 clinics.

Alan Glaseroff, MD, Chief Medical Officer of Humboldt-Del Norte Foundation, Eureka CA., who has directed the development of the Humboldt Diabetes Project. Since 2002 the Project has maintained a centralized record system for managing the county's patients with diabetes, keeping records and making them available to medical practices within the entire county.

W. Cyrus Jordan, MD, MPH, Medical Director of the Vermont Program for Quality in Health Care  (VPQ), Montpelier, VT, an independent quality improvement organization. VPQ formed the Vermont Chronic Care Collaborative (V3C), which has developed the Vermont Health Record, a Web-based clinical information registry now used in more than 20 practices in the state.

Janet (Jessie) Sullivan, MD, Chief Medical Officer of Hudson Health Plan, Tarrytown, NY, a not-for-profit Medicaid managed care organization that has assisted four of its providers in installing a diabetes registry called CareFocusTM in 2004. CareFocus was developed by Hudson Health Plan in collaboration with the New York Diabetes Coalition, which Dr. Sullivan chairs.

 The report, "Diabetes Registries Roundtable Proceedings," is available at no charge and can be ordered by calling Hcheq at 1.914.371.2100 or e-mailing therman@hcheq.org  It is also available on the Hcheq website (www.hcheq.org ).

About the Hudson Center for Health Equity & Quality (Hcheq)
The Hudson Center for Health Equity & Quality (Hcheq) was formed in 2004 by Hudson Health Plan to advocate for universal health care and other policies to broaden health care access, and to develop information technologies for improving the quality, safety and efficiency of medical care.  In May, Hcheq held its inaugural conference, "After Katrina: Achieving Access and Equity in Health Care." "Diabetes Registries Roundtable Proceedings" is the Center's first published report. For more on Hcheq, visit www.hcheq.org

About Hudson Health Plan
Founded in the mid-1980s by a coalition of community health centers, Hudson Health Plan is a not-for-profit Medicaid Managed Care organization with nearly 60,000 members in New York's lower Hudson Valley. A leader among health plans, Hudson Health Plan has been driving health care innovation by developing technology to support clinical quality initiatives and streamline the enrollment process for Medicaid Managed Care, Child Health Plus, and Family Health Plus.

Hudson Health Plan is the winner of the 2006 Poughkeepsie Journal Diversity in the Workplace Award; the 2005 Dr. Martin Luther King Jr. Corporate Award for diversity from the YWCA of White Plains and Central Westchester; the 2005 Advancements in Health Care Award from Hudson Valley Life and Hudson Valley Parent; and the 2003 Community Leadership Award from New York Health Plan Association.
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