Annals of Family Medicine

NOVEMBER 20, 2024

Context: Patients with diabetes who receive structured and integrated care have better control and outcomes; however, care may shift between multiple settings making coordination challenging. Outcome Measures: Number of patients engaged, resulting referrals, Navigator time per patient, and hemoglobin A1c measures across 2-years.

Primary Care 130

Primary Care Diabetes Referral Integrated Care 130

Annals of Family Medicine

NOVEMBER 20, 2024

Context: This work was done in the context of a regional quality improvement (QI) collaborative funded by the Ohio Department of Medicaid (ODM) focused on advancing diabetes equity through cross-sectoral QI infrastructure. We are one of 6 regional QI collaboratives statewide.

Community 130

Community Diabetes Referral Screening 130

Dr. Zaar

JUNE 1, 2025

Managing Type 2 diabetes requires more than just medication—it demands a long-term partnership with a skilled healthcare provider who understands your individual needs. Choosing the right diabetes doctor can make a major difference in how effectively your condition is managed, your quality of life, and your long-term health outcomes.

Diabetes 52

Diabetes Board-Certified Management Internal Medicine 52

Permanente Medicine

JUNE 3, 2025

When you put in that referral, how do we make sure that that patient walks out with the specialty appointment versus phone tag. Let’s say a diabetic comes in and they’re on metformin. They’ll also pen the rheumatology referral. We’ve been enhancing that and we share that with the other markets.

IT 52

IT Patient-Centered Patients Medical 52

GeriPal

SEPTEMBER 7, 2023

So pretty soon, I hope, we’ll be able to do this all electronically by anyone who wants to. ” Whether it’s referrals that need to be made, or whether they’re specific actions that the person at home needs to take, like a home safety change. Or electronically, to fill out, right? This is terrific.

Patient-Centered 130

Patient-Centered IT Patients Clinic 130