EPN Diabetes Patients with 2 Visits in the Prior 12 Months

Initiative		Comprehensive Diabetes Care
Metric		Appropriate Office Follow Up
Definition		Patients with Diabetes age >18 seen by their Primary Care Physician at least 2 times in the past 12 months
Measurement		Percentage of patients meeting the metric definition
Numerator		Number of patients seen twice in the past 12 months
Denominator		Number of patients with a Diabetes diagnosis in their EPICare problem list
Exclusions		Patients residing in a nursing home Patients new to EPN within the last 6 months Patients with a new Diabetes diagnosis within the past 6 months Patients referred to an Endocrinology Specialist for care
EPIC Support		Monthly reports distributed to practices identifying patients overdue for visits
Network Goal		>90%