| 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% |