The Metrics of Success
Through participation in the AMGA Together 2 Goal® collabo-
rative, LVPG realized success in the four metrics despite an
increasing prevalence of 0.6% of patients newly diagnosed
with diabetes (N = 25,620) and newly diagnosed diabetes
(N = 6,114):
X HbA1c control improved from 63.6% to 65.4%.
X Blood pressure control increased from 73.2% to 78.7%.
X Medical attention for nephropathy rose from 85.9% to 88%.
X Lipid management with statin went from 67.4% to 70.9%.
Furthermore, HbA1c not performed in over one year dropped
significantly, from 14.4% to 10.7%. LVPG bundled performance
in meeting all four measures significantly improved, from 32%
One outcome LVPG’s dissemination team also perceived was a
heightened level of integration and teamwork. Many staff felt
they were performing at a higher level and delivering better
patient care than previously, which was met with significant
positivity and improved job satisfaction. This potentially benefits provider/staff burnout.
with Type 2
of Type 2
2016 Q1 140,511 19,506 13.9%
2016 Q2 140,625 19,459 13.8%
2016 Q3 143,255 19,722 13.8%
2016 Q4 146,490 19,992 13.6%
2017 Q1 149,019 20,313 13.6%
2017 Q2 150,681 20,718 13.7%
2017 Q3 151,843 21,204 14.0%
2017 Q4 158,029 22,247 14.1%
2018 Q1 168,175 23,954 14.2%
2018 Q2 177,297 25,620 14.5%
learning, our team created a dashboard with all the requisite
functionality critical to perform ambulatory QI, including real-time analytics and feedback reporting.
The last significant barrier was inconsistent staff workflow
compliance. Key to the DM2 pathway is clinical staff performance of pre-visit planning and management of “not met”
care gap reports. Our implementation team realized that staff
competence in these workflows varied, requiring ongoing
development to ensure clerical and clinical staff perform at
the “top of their license.” This observation often led our team
to provide additional elbow-to-elbow support, resulting in
downstream improvements in other quality workflows and
Where to Begin
To replicate our successes surrounding this care pathway, we
recommend that you begin with a dedicated RIE to map your
process, identify your gaps and countermeasures, and, subsequently, create your standards and workflows. This work
must yield a complete pathway meant to be only minimally
modified but not substantially changed during the socialization process. Other local initiatives in our medical group
have stalled due to prolonged planning that could have been
accomplished with a single dedicated RIE event with all key
Leverage involved members to comprise your dissemination team. In addition, structure your dissemination
schedule and program, both intentionally and systematically. Having structure to your rollout allows for consistent
outcomes and improved process.
We continue to leverage lessons learned from this work to
replicate similar impacts in other areas. The dissemination
model has become a standard for us when deploying any
future ambulatory QI initiative. Sustaining change requires
focused effort. Leveraging models such as this can assist in
creating a “sugar rush” in any organization.
Jennifer Stephens, D.O., FACP, chief medical officer, Lehigh Valley
Physician Group (LVPG), specializes in internal medicine at LVPG in
Allentown, Pennsylvania. Janelle Sharma, DNP, CRNP, director of
quality, Lehigh Valley Physician Hospital Organization, specializes in
family practice at LVPG Bangor, Pennsylvania. Brian Shablin, M.D.,
specializes in internal medicine at LVPG. Kerri Vincent is clinical
quality specialist for the Department of Medicine. Megan Boyer,
R.N., B.S.N., is clinical educator for LVPG Clinical Services. Hallie
Melnick, R.N., B.S.N., is clinical quality educator, LVPG Clinical
Services. Magdalene Cruz-Rivera, R.N., B.S.N., is LVPG clinical
quality educator, LVPG Clinical Services. Richard MacKenzie, M.D.,
is senior vice chair, Department of Emergency and Hospital Medicine,
and medical director, Organizational Effectiveness for Lehigh Valley
Health Network specializing in emergency medicine.
1. American Diabetes Association. 2018. Accessed November 13,
2018 at diabetes.org.
2. D. Zatzick, L. Tuzzio, D. Chambers, et al. No date. Dissemination
and Implementation: Section 7, Stepped Wedge Designs.
Bethesda, MD: National institutes of Health Collaboratory.
Accessed November 13, 2018 at rethinkingclinicaltrials.org/