Delivery System Design:
Assign Roles, Duties, and Tasks for Planned Visits to a Multi-Disciplinary Care Team
- Determine who has responsibility for each step of the planned visit.
- Obtain senior leader support for training staff in new roles and tasks.
- Identify who will do the training.
- Identify resources, training material, and tools.
- Offer opportunities for the staff member being cross-trained to shadow or observe the staff member doing the procedure (e.g., foot exam).
- Train providers, medical assistants, nurses (e.g., self-management goal setting and follow-up, phlebotomy), and periodically check staff competency with tasks.
- Use standing orders for referrals.
- Query registry monthly for all diabetes patients due or overdue for eye or dental exam.
- Give list of due or overdue eye or dental exams to designated referral person, who then makes referral automatically from monthly list of overdue exams, etc.
- Use standing orders for labs.
- Develop standing orders for nurse or dietician.
- Educate nurse and dietician on use of standing orders.
- Use registry to identify patients who need labs and send letters to patients requesting they get them.
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