Diabetes exacts its toll on many Americans, young. and old. American Diabetes Association estimates that nearly of the complications of diabetes, which …
Division of Medicine
Department of Endocrinology and Metabolism
Staff
Jose M Cabral, MD Vineeth Mohan, MD Pascual De Sanctis, MD Erlinda Rosenkranz, MSN, ARNP
1
Chairmans Letter
The Department of Endocrinology and Metabolism is committed to excellence in the care of patients with a wide range of adult endocrine diseases, such as, diabetes, osteoporosis, thyroid, adrenal, gonadal and pituitary disorders I am very pleased to share with you our Departments quality and outcomes data By measuring disease specific outcomes and data we continually improve the care and life of our patients Over the last decade we have developed innovative programs for the management of patients with diabetes with office-based ADA-certified diabetes selfmanagement education, insulin pump training, diabetes group medical visits and support groups The Thyroid Diagnostic Clinic has streamlined the accessibility of patients with thyroid nodules and cancer with point-of-service ultrasounds and fineneedle biopsies in close collaboration with our surgical and nuclear medicine colleagues The Osteoporosis Center provides state-of-the-art DXA bone densitometry and consultations by a dedicated certified technician
and board certifiedendocrinologists
I hope that you find this booklet a useful source of information about our services Jose M Cabral, MD, FACE Chairman, Department of Endocrinology and Metabolism
2
Innovation
The challenge of providing access to specialized and high quality medical services has led to the development of innovative programs in our Department Diabetes Shared Medical Appointments Cleveland Clinic Florida was the first to introduce the Diabetes Shared Medical Appointment SMA concept in South Florida in January 2004 The SMA program allows multiple established patients to be seen as a group for routine diabetes care These visits provide a secure, interactive setting in which patients have improved access to their endocrinologist, diabetes educators during a focused 90 minute group visit Patients share experiences and advice with one another Since its introduction, over 700 patients have participated in a diabetes SMA The program has attracted significant attention and the recognition as Finalist at the Excellence in Healthcare Awards from the South Florida Business Journal, Excellence in Non-profit Healthcare Program 2006
management education, insulin pump training,
diabetes group medical visits and support groups The diabetes team specializes in the management of complex diabetes cases Two full-time diabetes educators and a nurse practitioner work closely with the staff endocrinologists Diabetes Self Management Classes Diabetes is a global epidemic that touches every life differently At the Department of Endocrinology, each patient and their family receive individualized attention Our diabetes education team provides skills to patients that help to maximize the potential for excellent outcomes In addition to individual appointments, the staff provides group Diabetes Self Management Classes once a month during the weekdays and on some Saturdays We also offer ongoing Diabetes Support Groups monthly at our facility Diabetes Education Staff is available to teach self-management skills in: Insulin administration Blood glucose monitoring Insulin pump therapy Blood glucose pattern management Nutrition therapy Patients attending our group Self-Management Diabetes Classes have shown to decrease their HbA1c approximately 12 after diabetes education classes
Services
Diabetes Services Our diabetes team has developed innovative programs for the
management of patients with diabetes with office-based ADA-certified diabetes self-
3
Osteoporosis Center Osteoporosis can be a devastating disease that can lead to fractures and disability The Department of Endocrinology offers on site DXA Bone Density testing and consultations for osteoporosis and metabolic bone diseases provided by a dedicated certified technician and endocrinologists In our institution the Department of Endocrinology performs the vast majority of the DXA bone density studies which assures interpretation by the endocrinology staff
1174
1200 1000 800 600 400 200 0
Bone Density
Urology laparoscopic adrenalectomies and Neurosurgery pituitary Thyroid Diagnostic Clinic The Department of Endocrinology at Cleveland Clinic Florida has become a leading center for thyroid disorders in South Florida The Thyroid Diagnostic Clinic has streamlined the accessibility of patients with thyroid nodules and cancer with point-of-service, same day ultrasounds and fine-needle biopsies by endocrinologists in close collaboration with our surgical, otolaryngology and nuclear medicine colleagues We also provide evaluation and treatment of hyperparathyroidism, hyperthyroidism and
hypothyroidism Pituitary Disorders Diseases of the pituitary, including, pituitary tumors, prolactinomas, panhypopituitarism, adult growth deficiency, Cushings diease and acromegaly are treated in collaboration with the Department of Neurosurgery Endocrine Hypertension The department has a particular interest and expertise in adrenal disorders and adrenal causes of hypertension, such as, primary aldosteronism and pheochromocytomas For surgical cases, minimally invasive laparoscopic surgery is perfomed by the Department of Urology in close collaboration with our Department
654
2004
2005
2006
280
Endocrine Surgery Services Endocrine disorders which require surgery thyroid, parathyroid, adrenal and pituitary tumors are managed in a true multidisciplinary approach in close collaboration with our highly experienced surgical colleagues in the Departments of General Surgery and ENT thyroidectomies and parathyroidectomies, Minimally Invasive Surgery,
4
Caring
Testimonials from our patients I was diagnosed with diabetes several years ago, was given limited diet and exercise information and basically was left to cope on my own I hold degrees in retailing and marketing but neither of
those facts prepared me to deal with 
the complexity of diabetes Attending the Diabetes Self Management Classes provided scientific, technical information about monitoring blood glucose levels and the appropriateness of the medication schedule Prior to my time attending classes counseling regarding medication had been limited to a review of the lookback procedure and a prescription Your Clinic is to be commended for the quality of staff and their effectiveness with clients George P Your records will reveal that I have been a beneficiary of your expertise and care for more than 15 years My employer, Don King, and I moved to South Florida in early 2001 He directed me to you for which I am eternally grateful I write this letter to express my gratitude for your counsel, care and assistance I truly look forward to having the benefit of your advice and care for many years to come Charles L
I have learned more about diabetes control in our one on one vist than in the past 17 years since my daughter was diagnosed with type 1 More importantly, carb counting is helping me nip the highs in the bud, keeping me within my target level I couldnt have done it with you Thanks again Tony V I would
of never got through this without you I will always remember you Christen I Your explanation of the insulin injection system was very clear and informative Although we arrived late in the day, you took time to explain everything and filled out all the forms Thank you for a job so well done Michael S Wanted to drop you a line to let you know that my job as relocated me to the Atlanta, GA area I will always remember and be grateful for all the assistance and laughs that you shared with me, while getting the insulin pump Laura I just wanted you to know what an excellent Clinic class that you conducted Being relatively new as a diagnosed diabetes type 2, I wanted to be informed and develop a family plan of action to manage it You provided an excellent format to do that, as well as a heightened awareness of the necessity to apply this information As a management consultant, I look for the degree of preparation, content and delivery I give you very 5
high marks on this and you exceeded my expectations From my initial phone contact with you regarding the program, I was impressed with your professionalism and dedication
Quality Outcomes Measures
Diabetes
The prevalence of diabetes has
increased dramatically over the last two decades and is a major public health concern Diabetes care that provides good patient outcomes is of paramount importance In our Department patients with diabetes are seen are seen mostly individually IA and some are seen in our Diabetes Shared Medical Appointment Program SMA We analyzed patients with type 2 diabetes for at least one year duration and followed in our Department for at least 6 months We included in this study patients with at least 3 visits within a period of 8 months Patients excluded for this analysis were those who didnt meet the inclusion criteria, had a gastric bypass surgery
Patient Satisfaction
We ask our patients about their experiences and satisfaction with the services by our staff Although our patients are already indicating we provide excellent care, we are committed to continuous improvement
Our innovative method of Shared Medical Appointment has been an exceptional success with our patients
Scheduling Experience Satisfaction w/ Date Satisfaction w/Clerical Staff Satisfaction w/Nursing Staff Satisfaction w/ Room Medical Needs Questions Addressed Satisfaction w/Physician Satisfaction w/ Privacy
Confidentiality Convenience w/Checking Out Overall Experience
Type of visit
SMA IA
The performance outcomes for our Department are higher than the national measurements when the patients are seen individually or as a group with excellent patient satisfaction
4
41 42 43 44 45 46 47 48 49 5 Level of Satisfaction on a 1 to 5 Scale 1Poor, 5 Excellent
6
LDL mg/dL
Performance based on the Diabetes Physician Recognition Program Measures ADA NCQA
Measures HbA1c 7 HbA1c 9 LDL 100 mg/dl LDL 130 mg/dl Criteria 40 15 36 37 25 35 IA 1st visit IA 3rd visit SMA 1st visit 47 9 72 14 80 11 50 7 74 11 86 11 53 0 75 3 74 15 SMA 3rd visit 50 0 89 3 75 11
100 90 80 70 60 50 40 30 20 10 0
0310
0038
SMA IA
Baseline
6 Months
Ind Sample T-test
Systolic Blood Pressure
128 126 124 122 120 118 116 Baseline 6 Months
Ind Sample T-test
0520 0844
BP 130/80 mm Hg BP 140/90 mm Hg
SMA IA
Threshold that meet criteria for Diabetes Physician Recognition Program
Diastolic Blood Pressure
70 695 69 685 68 675 67 665 66 655 Baseline 6 Months
Ind Sample T-test
0184 0296
SMA IA
7
Diabetes Education
The Cleveland Clinic Center for Diabetes Education in our Department of Endocrinology is a Diabetes
SelfManagement Education Program certified by the American Diabetes Association Patients receive education in the Department either in group sessions or individually with our diabetes educators The change in glycemic control was quatified with HbA1c measurement at baseline and at 6 months after education The average improvement in HbA1c was approximately 12 HbA1C at baseline 6 months
9 8 7 6 5 4 3 2 1 0 2004 2005 2006 Pre Post Change
Thyroid Biopsies and Ultrasounds
The Thyroid Diagnostic Clinic has allowed our Department to provide on-site diagnostic thyroid ultrasounds, consultations and ultrasound-guided fine-needle thyroid biopsies, frequently during the same visit This allows a very efficient thyroid evaluation and patient experience
800 700 600 500 400 300 200 100 0 Ultrasound
745
256
289
2004 2005 2006
8
Endocrine Surgery
Cleveland Clinic Florida surgeons offer surgical care for patients with thyroid, parathyroid, adrenal and pituitary glands The Department of Endocrinology collaborate closely with our surgical teams in the diagnosis, localization and management of these patients
90 80 70 60 50 40 30 20 10 0
2004 2005 2006
Thyroid
Total Thyroid
Parathyroid
Parathyroid
9
Source:clevelandclinic.org
