Ending Type 2 Diabetes One Exercise, Nutrition, and Gardening Class at a Time

Posts Tagged ‘Children and OGTT Screenings’

FHCHC DPP OGTT Screening Billing Flow

In OGTT Screening on December 8, 2010 at 1:06 PM

FHCHC’s Diabetes Prevention Program has strived to create a financially sustainable billing system. This is a month in the life of the OGTT billing process.

This document refers to several related documents:

Click here for a sample Encounter Form

Click here for sample coupons

Click here for a sample OGTT attendance, billing, and insulin data spreadsheet

FHCHC DPP OGTT Billing Spreadsheet

In OGTT Screening on December 8, 2010 at 1:06 PM

The FHCHC Diabete Prevention Program maintains spreadsheets for all data to ensure research accuracy. This spreadsheet chronicles the relevant patient, billing, and insulin numbers for all OGTT screening attendees.

For a look at the whole billing flow, click here.

FHCHC OGTT Execution Checklist

In OGTT Screening on December 8, 2010 at 1:03 PM

This checklist is meant to guide DPP staff in conducting a successful OGTT screening.

DPP Financial Sustainability: No Special Treatment

In About the Program on December 8, 2010 at 1:03 PM

“The DPP gets no special treatment” declares FHCHC’s billing manager Marian Zayas. She is referring to the billing system used to ensure DPP financial sustainability. Knowing that neither the clinic nor grants could finance the program for more than several years, exploring and establishing an effective billing system has been a key objective from day 1.

Like other health clinics, FHCHC positions patients on a sliding fee scale based on their income and insurance status (see scales below). Those with no insurance combined with lowest income level are given the biggest discounts, while those with insurance and/or high income are given the lowest discount. The DPP has fully adopted this system so that each patient seen in an OGTT screening or participating in the Intensive Lifestyle Intervention is charged for their visit based on their position on the sliding fee scale. The DPP uses a coupon system to ensure that the DPP is charged for serves not covered by patients’ insurance (click here for a sample coupon sheet).

Click here to see the OGTT billing process which ensures insurance reimbursement and program sustainability.

FHCHC DPP OGTT Billing Coupon System

In OGTT Screening on December 8, 2010 at 1:02 PM

These are the coupons that the DPP staff pastes on Encounter Forms after OGTT Screenings. By using a coupon system, the Billing Department can charge the DPP the amount that isn’t covered by the OGTT screening patients’ insurance.

Click here to see the whole OGTT billing process.

DPP Research Flow: OGTT -> Preventative Interventions -> OGTT

In About the Program on December 8, 2010 at 1:02 PM

FHCHC DPP OGTT Preparation Checklist: For the Brilliant at Heart

In OGTT Screening on November 26, 2010 at 11:44 AM

…at the start of the twenty-first century: We have accumulated stupendous know how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageabe. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields – from medicine to finance, business to government. Ant he reason is increasingly evisdent. : the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.

That means that we need a different strategy for overcoming failure, one that builds on experience and takes advantage of the knowledge people have but somehow also makes up for our inevitable human inadequacies. And there is such a strategy – though it will seem almost ridiculous in its simplicity, maybe even crazy to those of us who have spent years carefully developing ever more advanced skills and technologes.

It is a checklist.

From: The Checklist Manifesto by Atul Gawande, 2009


Executing a group family-based OGTT screening is no simple task. Below is the checklist the DPP staff uses to ensure success.

OGTT Screening Flow Chart

In OGTT Screening on November 11, 2010 at 11:11 AM

This chart illustrates the path the a typical patient would travel through the DPP’s OGTT screenings. The model is meant to serve between 20-35 patients at once, and welcomes children and adults alike.

Are You There? 2 Solutions for a Common OGTT Recruitment Breakdown

In OGTT Screening on November 9, 2010 at 4:23 PM

It’s been two weeks and Eva is making her third attempt to reach Sandra. Referred by her provider to get screened, Eva sits looking dejected in front of the referral note (click here for the OGTT recruitment write-up script).

Out of 20 referrals, Eva typically reaches five. The remaining 15 are unreachable – either not home or sporting a disconnected phone number. Eva leaves a message with those who have answering machines or someone capable of taking a message. Two or three will return her message. Now, what happens with the remaining 12 or 13 patients who were never spoken with after their provider wrote them an OGTT referral? Herein lies the rub.

A note is written on their referral form, and it is returned to the chart, filed away until the patients’ next scheduled PCP appointment. When is that appointment? Someday (indeed, elusive someday) in the future.

The problem with this scenario is not colossal: if the PCP has an urgent concern for the patient’s blood glucose level, they schedule an individual OGTT screening lab for that week as opposed to writing a group OGTT screening referral. An emergency, therefore, is not the problem. The main drawbacks of this system are as follows:

1) If the provider requests additional blood tests, like TSH, on that referral form, those requests are lost.

2) The elusive someday is truly elusive; for one reason or another the patient might not return to the clinic for years, by which time their prediabetes could easily have metamorphosed into type 2 diabetes.

A simple solution to this systems breakdown is to file the referral form into the referring providers’ folders after our Diabetes Prevention Program staff has finished with them, instead of into patients’ charts. Providers would then have the opportunity to see and, most importantly, react to the outcome of their referral request – whether that be to send a letter out themselves to those who were unreachable or note that the patient is scheduled for their screening.

Possible solution #2 is to attach a scheduling form to each referral form. In the moment that the provider chooses to refer the patient to a screening, a date and time would thereby be assigned. Both the scheduling and referral forms would get routed to the DPP office, and the DPP staff would take it from there, ensuring that the patient was set up to attend the screening.

OGTT’s Evolution from Pilot to Paramount

In OGTT Screening on October 25, 2010 at 4:14 PM

There was a marked increase in the number of patients screened for diabetes and prediabetes when the Donoghue grant became operational. From 2006-2008 under the Connecticut Health Foundation’s initial grant, research was limited to hispanic women between the ages of 18-55 years old. Limited is not the best word, however. The number of Oral Glucose Tolerance Test (OGTT) patients perfectly matched the structures and resources available to the Fair Haven Community Health Center at the time.

During this initial 2-year period, OGTT screening referrals amounted to approximately 2-4 per week. Clinicians generated them conservatively, being new to the group-screening paradigm. One Diabetes Prevention Program staff member handled the entire referral to recruitment process. She stocked exam rooms with referral forms, collected filled-out forms each Friday. She called each patient within 3 weeks to schedule them for a screening, and filed the referral forms in patients’ charts herself. Mari also kept impeccable excel spreadsheets on all relevant numbers and names.

In 2004, when the clinic won a substancial Donoghue Foundation grant, however, this system needed to be expanded. Now, any patient that displayed a risk factor was offered a free diabetes screening. Having observed the previous two years’ success, clinicians were poised and ready to ramp up their referrals. And they did! Referrals went from the aforementioned 2-4 per week to 20-25 per week. The Diabetes Prevention Program had to hire another staff member who shared the referral and recruitment responsibilities. Once in a while there were so many referrals that Eva had to set aside entire series of workdays just to make referral calls. To meet the demand, the Diabetes Prevention Program also increased their screenings from one per month to three.  The success, therefore, of the initial two years of ‘limited’ access screenings established the program’s credibility and systematic foundation.

The Donoghue grant, however, made it possible for any patient at the Fair Haven Community Health Center, whether male female, child or adult, Balinese or African American, to get screened. Today, the DPP receives between 20-25 OGTT screening referrals per week, a major increase from the 2-4 one year ago.

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