Lean Implementation for Graduating Optimally Controlled Stable Type 2 Diabetics from Endocrine Specialty Clinic Back to Primary Care

Lynn A. Burmeister, Peter G Harper, Alvina Brueggemann, Pita Adam, Mary Logeais, Kelly Schechter, Katie Duncan, Holly Boyer

Research output: Contribution to journalArticlepeer-review


Introduction: Endocrine specialty clinics (SCs) are occupied by a high percentage of stable follow-up patients, limiting access to new patients with greater needs. Aim: Feasibility project to improve access to diabetes SC by reducing the number of stable optimally controlled follow-up type 2 diabetic patients. Setting: M Health Fairview (MHFV), a hybrid network of University of Minnesota academic and Fairview Health community hospitals and clinics with affiliated providers. Program Description: A team-based lean methodology quality improvement graduation program including medical assistants, nurses, physicians, and a compact with primary care (PC) was used to identify within the Endocrine clinic population the graduation-eligible optimally controlled stable type 2 diabetic patients, acclimate them to the graduation concept, engage in shared decision-making, and transition them back to PC with a warm hand-off and graduation certificate. Program Evaluation: Seventeen percent (58/341) of eligible patients with optimally controlled diabetes graduated by 6 months, ranging between 0 and 83% per week. Discussion: The innovation and feasibility of opening SC access through the use of a team-based graduation program to transfer stable diabetes patients back to their home clinic was demonstrated. This innovation has the potential to support health system triage of new patients to limited access specialty care.

Original languageEnglish (US)
Pages (from-to)4004-4007
Number of pages4
JournalJournal of general internal medicine
Issue number15
StatePublished - Nov 2022

Bibliographical note

Funding Information:
We wish to acknowledge the hard work of our entire clinic staff including schedulers, roomers, nurses, coordinators, clinicians, quality team members, and Vizient team members. It took the entire team to do this work. M Health and Vizient Impact team members (in alphabetical order). Graduation Program implementation: Patricia Adam MD, Nancy Arntson RN, Alvina Brueggemann PhD, Amanda Brummel PharmD, Lynn A Burmeister MD, Mariah Chung, Jackie Doll RN, Katie Duncan CMA, Renae Grossman RN, Peter G Harper MD MPH, Mary Logeias MD, Tina Lonsky RN BSN, LaTosha Lopez RN, Mark Renslow, Kelly Schechter RN, Lauren Vikla RN. Other Impact teams: Mari Akre RN PHD NEA-BC, Aylin Altan, ,Teresa Benge RN CDE, Nicole Beauvais PAC MPH, Holly Boyer MD, Evie Buczkowski MS RN CPMSM, Lois Droogsma, Megan Foley MBA, Kathryn Frias CMA, Rebecca Korach MHA,Ella Kot RN BSN, Liz Marie Martin, Joe Mac Donald MD, Exra Menon, Pa Moua, David Muir RN MBA MSN FNP, Colleen Oldham MSN RN FACHE, Amy Parley, Madeleine Ringham CMA BA, Aman Sabharwal MD, Jennifer Sarno MSN ACNP-BC, Kelly Schweim PharmD MTM, Tyler Starr, Maureen Sullivan RN, Katelyn Vietti, Tomas Villanueva DO MBA FACPE, Barbara Wallace, Matt Warhol, Kirsten Welge, Jeff Wood, Kathy Zard, Anthony Zhu.

Funding Information:
This work was supported by Funding Opportunity number CMS-1L1-15-003 from the US Department of Health & Human Services, Center for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official view of HHS or any of its agencies. The Vizient Practice Transformation Network is 100% funded with Federal US Department of Health and Human Services (HHS) funds, provided by the Center for Medicare and Medicaid Services.

Publisher Copyright:
© 2022, The Author(s).


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