Toolkit for Implementing the Chronic Care Model in an Academic Environment: Delivery System Designs

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Toolkit for Implementing the Chronic Care Model in an Academic Environment

Diabetes Care Summary

Oregon Health & Science University's Diabetic Care Summary sheets are a critical part of the improvement success for this team. These summary sheets provide a snapshot of each patient's care status, serve as reminder of the treatment protocol, allow for a longitudinal view of the patient's response to care over time, and provide a focus for the team huddles and care planning for each patient.

Sample Diabetic Care Summary sheets. Fields include Current Treatment, Current Meds, Diabetes Type, and Comorbidities. Sections below allow updates on the patient's Blood Pressure/Weight/BMI, Glycohemoglobin, Lipid Control, Eye Care, Renal Care, Foot Care, Tobacco Use, Vaccinations, and Self-Managment Goals.

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