Improved Visit Planning: Can It Lead To A Higher Level Of Quality Care?

By Barbara Aung, DPM and Kim Jungkind, MPH, RN, CCM

   Podiatric medical practices strive to provide patients with high quality care. Patients with diabetes pose an added challenge due to the comprehensive nature of the condition and resulting complications. In a proactive effort to improve visit planning and improve the care of these patients, podiatrists may want to consider the use of software decision support and tracking tools to assist them in delivering needs-based care to their patients.    We have found success with a simple, practical registry, decision support and tracking system. As a “connected health record,” the DocSite PatientPlanner incorporates evidence-based guidelines at the point of care for patients with diabetes. The approach has general applicability for fostering best clinical practices.    Last year, we took a closer look at the impact of using this software decision support package in an Arizona-based podiatry practice. Going into this project, we believed that improving the efficiency and effectiveness of the practice could help facilitate a higher standard of care for patients with diabetes.    The staff implemented the decision support and tracking tool as they scheduled routine office visits for patients with diabetes. The office made a clear decision to enroll patients in the system as they came through the office as opposed to enrolling via a retrospective chart review. By enrolling prospectively, it was not necessary to garner resources outside of the day-to-day office flow.    Planning seemed to be the key word as educational efforts and an expanded patient assessment became the new objectives for this podiatric medical practice. The expanded assessment addressed several areas including diabetic shoes, diabetic inserts, dilated eye exams, lab testing and a review of current patient medications. The results included opportunities to improve care and to enhance service delivery from the practice.

How Visit Planning Helps You Meet Patient Needs

   The software tool assists the podiatrist and the office staff in the areas of visit planning, scheduling follow-up visits and analyzing practice effectiveness. The program supplies not only specific details related to the care the given patient will need at that visit, it also creates a method for bringing patients back for appropriate follow-up. Additionally, the program provides a reminder approach to managing patients.    The “Visit Planner,” or encounter form summary sheet, tracks all of the patients’ clinical management needs, providing an easy way to incorporate clinical guidelines and evidence-based care delivery that is based around the patient’s needs.    At the beginning of the day, the staff prints out the Visit Planner for each patient with diabetes. They place this sheet on the patients’ charts and it serves as the summary of all clinical activities and follow-up needs for the patient. The Visit Planner can include lab results, demographic data, pharmaceutical agents, allergies, etc. The DPM uses the Visit Planner during the direct patient assessment. The planner documents changes in the treatment, meds or other follow-up needs.    After the visit is complete, staff members use the Visit Planner and the chart for updating in the computer through Web-based access. Updating the online patient information takes less than one minute.    In addition, the system tracks several measures of diabetes. These include A1C, type of diabetes, smoking status, capillary refill, DP and PT pulses, protective sensation, fungal nails, foot risk assessment (low and high), diabetic shoes, diabetic insoles and lower extremity orthotics.

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