Background: Allegheny Health Network Diabetes Support Initiate for Primary Care (AHN DSIPC) developed the Diabetes Clinical Quality Reporting Tool (DCQRT) to assess diabetes measures in primary care practices (practices). Methods: The data for the DCQRT was accessed via PROC SQL for SAS Enterprise Guide 7.1 from the Clarity Prod Copy of our EPIC Electronic Health Record. The data was shared with practices in aggregated format with Tableau. Patients were attributed to a practice based on primary care provider designation in EPIC. Patients’ data was included if the following criteria were met: in the EPIC diabetes registry; between age 18 to 75; seen in the practice at least once within the report quarter. The DCQRT includes 7 measures shown in the Table. For the A1C measure, we risk tiered patients based on the antidiabetes medication as a surrogate for disease severity. A1C at goal was assigned as follows: no antidiabetes medication<7%; oral antidiabetes medication<7.5%; non-insulin injectable antidiabetes medication<8%; insulin <9%. Results: See Table. Table notes: * Performed within the last year# Age 40-75 ^data available in Q4 2016. Conclusion: The DCQRT allowed assessment of diabetes measures in practices in a health network. The DCQRT has allowed practices to see data in an aggregate form and base quality improvement initiatives. Disclosure J. Pennock: None. B.M. Klein: None. M.S. Stevens: None. E. Kraemer: None. Funding Richard King Mellon Foundation
Sleep is essential. Sleep is complicated. Sleep is more than obstructive sleep apnea. These truths are evident to those of us practicing sleep medicine. After training in sleep medicine, we can confidently recommend continuous positive airway pressure for obstructive sleep apnea or prescribe clonazepam for what seems to be a parasomnia, but what do you do if those treatments don't fix the problem? This is the crux of the book Case Studies in Sleep Neurology. This 318-page book details 40 case presentations of sleep disorders with a neurologic angle, and thoroughly discusses them from start to finish. Each chapter begins with a history and examination. Some cases are "localize the lesion" cases. However, like most of our patients who present to the neurology sleep clinic, there often is no lesion to localize. There may be abnormalities on overnight polysomnography (if we are fortunate to solidify the diagnosis), but often we are left with a constellation of distressing nighttime activities leading to symptoms causing exhaustion, exasperation, embarrassment, and sometimes injury. These case presentations are enhanced by quality figures of neuroimaging, patient pictures, and polysomnography snapshots. Each chapter concludes with "Pearls and gold," which concisely presents the "need to know" information. Chapter authors are the best in the field, including Carlos Schenck, Mark Mahowald, Michael Silber, and many others. Antonio Culebras authors chapters and edited the book. The topics reviewed include insomnia, hypersomnia, nightmares, nocturnal hallucinations in a 24 year old, nighttime wanderings, nighttime violence resulting in subdural hematoma, repetitive nighttime jerking, and sexsomnia.Reading the case presentations is like reading a mystery novel and finding out the perpetrator at the conclusion of the case. The cases are gratifying with clinical follow-up incorporated into the discussion. Sleep neurology, neurosomnology, is a fascinating field that presents us with frequent challenges from patients in genuine distress over uncontrollable activity occurring in the part of their life spent in sleep. Case Studies in Sleep Neurology presents the cases in an easy-to-read manner and is packed with information. I highly recommend this book to those in any level of training ranging from medical students to neurosomnologists, and guarantee you (and your patients) will benefit. Kudos to Dr. Culebras for this educational book, and for his seemingly endless contributions to the field of neurosomnology. Reviewed by M. Suzanne Stevens, MD, MS, D-ABSM
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