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------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/master20.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0102.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
<= span style=3D'mso-special-format:nobullet;display:none;color:#B2B2B2;mso-color-= index: 7;font-family:Wingdings;font-size:90%'>nChronic Disease Management in a Fam= ily Medicine Residency
n
nJeffrey F. Minteer, MD =
nAssociate Director
nWashington Hospital Family Medicine Residency
njminteer@washingtonhospital.org
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Seatt= le 2007
n= Chronic Disease Management in a Family Medicine Residency
nSubtitles
n“Herding the cats”
nOrganizing chaos= 3;
nGeorge Jetson meets Fred Flintstone
n“Show me the money”
n<= span style=3D'mso-special-format:lastCR;display:none'>
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0091.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Chron= ic Care Model
Community
Health System
Organization of Healthcare
Decision Support
Delivery System Design
Clinical Information Systems
Self- Management Support
Resour= ces and Policies
Productive Interactions
Prepared, Proactive Practice Team
Informed, Activated Patient=
= Functional and Clinical Outcomes
Health System
3D"logo_icic-i"
The mo= del we chose to implement was the Chronic Care Model the purpose of creating  a more informed activated patien= t and a prepared proactive practice team working together in a partnership to improve functions and clinical outcomes.=   This model incorporates the paradigm shift from our current model = of heath care delivery that is problem-based designed to handle acute patient problems to a system that is prevention based to avoid long-term problems such as diabetes complications.  This however, is not done in isolation, it takes community resourc= es, self-management support (diabetes education classes), decision support (c= linical guidelines), Delivery system support which means designing the medical ca= re environment to support preventive care to accommodate the patients physic= al, psychological/psychosocial and educational needs (in our project we desig= ned diabetes “mini-clinics” or diabetes days and Clinical informa= tion systems, which in our study included chart audits to provide doctors with information as to what their diabetes care was like and also counseling t= hem to use their own data to make changes.&n= bsp; So as you can see, this is a multifaceted approach to behavior cha= nge involving many.  Using a multifaceted approach like this in a research study brings about many com= plexities in study design and interpretation, however testing just one component of= the model would not provide an accurate examination of its true effectiveness so…..
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Seatt= le 2007
n“Litt= le Worshington” Style Disease Management
Organization of Healthcare
Decision Support
Delivery System Design
Clinical Information Systems
Self- Management Support
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file:///C:/D08A14CD/JMinteerCDM_files/slide0039.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
nDisease Management “Little Worshington” Style =
nDelivery System Design
<= span style=3D'mso-special-format:bullet;color:#B2B2B2;mso-color-index:7;positio= n: absolute;left:-5.44%;top:.74em;font-family:Wingdings;font-size:55%'>n24  Family Medicine Residents
n15  Faculty
n40+ Support Staff&#= 13;
n3 Offices seeing 58,000 visits per year – residents account for 40%
nSchedules from &fra= c12; day in the office to 9 ½ days – none the same
nReassignment of pri= mary resident physician q 2-3 years
<= span style=3D'mso-special-format:bullet;color:#B2B2B2;mso-color-index:7;positio= n: absolute;left:-5.44%;top:.74em;font-family:Wingdings;font-size:55%'>n60% continuity
<= span style=3D'visibility:hidden'>n
n
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0110.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
nDisease Management “Little Worshington” Style
nPatient Population&#= 13;
n95% Caucasian <= /span>
n4-5% African Americ= an
n<1 % migrant wor= kers – Hispanic
nFinancial mix
n30% Medical Assistance
n20% Medicare
n? % Underinsured
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0093.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
nDisease Management “Little Worshington” Style
nDecision Support
nDepartment guidelin= es in a book
nCompetencies designed
nFlow charts buried = in EMR (3 clicks away)
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0077.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
n= Disease Management “Little Worshington” Style
nInformation Systems
nClinical Information System – Practice Partn= er 1997
nGood Summary/Historical Data – PPRNet
§Vendor-specific research network (historical reports back to 2002) <= /div>
§Practice Partner – extraction 
§MUSC (= http://www.musc.edu/PPRNet/) – data analysis
nSelf Management Support
nDiabetes Education Dept.
n
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0098.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
n“Litt= le Worshington” Style Disease Management
Organization of Healthcare
Decision Support
Delivery System Design
Clinical Information Systems
Self- Management Support
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file:///C:/D08A14CD/JMinteerCDM_files/slide0096.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
<= span style=3D'mso-special-format:bullet;color:#B2B2B2;mso-color-index:7;positio= n: absolute;left:-4.34%;top:.1em;font-family:Wingdings;font-size:90%'>nIncentives to change – The Perfect Storm
<= span style=3D'font-size:96%'>nImprove patient care
<= span style=3D'font-size:104%'>nSupport of dedicated staff
<= span style=3D'font-size:104%'>nExcellent Res= ident and Faculty staff
<= span style=3D'font-size:96%'>nRRC
<= span style=3D'font-size:113%'>nDesign of competency-based education
<= span style=3D'font-size:113%'>nDemonstrate QI projects
nATRIP (Accelerating Translation of Research into Practice) – PPRNet/MUSC research projec= t
nP4P – range $3 per E/M code to $9 (we were at = the $3 level)
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Seatt= le 2007
nWhy DM ?
nEverybody does Diabetes!!!!
n1000 + patients with diabetes
nLots of historical data
nMultiple disea= ses in one patient ( HTN, hyperlipidemia, renal disease, CAD etc)
nEasy to measure surrogate lab test
nMajor insurance carrier pay for performance
nAssociation of residency with the diabetes Education Department 
nPerformance deficiencies
nMajor Hospital focus on this disease=
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Seatt= le 2007
nHistorical Data (PPRNet)
<= span style=3D'font-size:65%'>n13 Diabetes-sp= ecific measures – since 2004
<= span style=3D'font-size:70%'>nDM patients= with glycosylated hemoglobin measured in past 6 months
<= span style=3D'font-size:70%'>nDM patients wi= th most recent glycosylated hemoglobin < 7%
<= span style=3D'font-size:70%'>nDM patients= with blood pressure measured in past 6 months
<= span style=3D'font-size:70%'>nDM patients wi= th most recent blood pressure <130/80
<= span style=3D'font-size:70%'>nDM patients= with LDL-cholesterol measured in the past year
<= span style=3D'font-size:65%'>nDM patients wi= th most recent LDL-C < 100 mg/dl
<= span style=3D'font-size:70%'>nDM patients= with HDL-cholesterol measured in past year
<= span style=3D'font-size:65%'>nDM patients wi= th most recent HDL-C > 45 mg/dl
<= span style=3D'font-size:70%'>nDM patients= with Triglyceride measured in past year
<= span style=3D'font-size:70%'>nDM patients wi= th most recent Triglyceride < 150 mg/dl
<= span style=3D'font-size:65%'>nDM patients >=3D40 years old on aspirin therapy
nDM patients= with urinary microalbumin measured in past year
<= span style=3D'font-size:70%'>nDM and HTN with current ACE inhibitor or ARB Rx
n Process (Insurance claims data) =
n Outcome
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= Benchmark: Line indicating achievable benchmark of care of 90th = percentile of all PPRNet practices at
baseline.
= o Median: Line indicating 50th percentile of all PPRNet practices at = baseline.
= o National: Line indicating published national data for the specific = measure (if available).
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------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0045.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
nHistorical Dat= a
<= span style=3D'font-size:65%'>n13 Diabetes-sp= ecific measures – since 2004
<= span style=3D'font-size:70%'>nDM patients= with glycosylated hemoglobin measured in past 6 months
<= span style=3D'font-size:70%'>nDM patients wi= th most recent glycosylated hemoglobin < 7%
<= span style=3D'font-size:70%'>nDM patients= with blood pressure measured in past 6 months
<= span style=3D'font-size:70%'>nDM patients wi= th most recent blood pressure <130/80
<= span style=3D'font-size:70%'>nDM patients= with LDL-cholesterol measured in the past year
<= span style=3D'font-size:70%'>nDM patients= with most recent LDL-C < 100 mg/dl =
<= span style=3D'font-size:70%'>nDM patients= with HDL-cholesterol measured in past year
<= span style=3D'font-size:70%'>nDM patients= with most recent HDL-C > 45 mg/dl &= #13;
<= span style=3D'font-size:70%'>nDM patients= with Triglyceride measured in past year
<= span style=3D'font-size:70%'>nDM patients wi= th most recent Triglyceride < 150 mg/dl
<= span style=3D'font-size:70%'>nDM patie= nts >=3D40 years old on aspirin therapy
nDM patients= with urinary microalbumin measured in past year
<= span style=3D'font-size:70%'>nDM and HTN with current ACE inhibitor or ARB Rx
<= span style=3D'font-size:65%'>n3 above the median – 2 outcome, 1 process
<= span style=3D'font-size:65%'>n0 at the benchmark
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0088.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seatt= le 2007
nPatient specific data
n
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Seattle 2007
nPatient specific data review (active patients) = ;
nMost patients were in the office for other <= span style=3D'position:absolute;top:50.0%;left:3.95%;width:93.25%;height:47.82%= '>problems – missed opportunities
nDepartment guidelines were applied variably
nContinuity /compliance / patient participation
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0097.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Chron= ic Care Model
Community
Health System
Organization of Healthcare
Decision Support
Delivery System Design
Clinical Information Systems
Self- Management Support
Resour= ces and Policies
Productive Interactions
Prepared, Proactive Practice Team
Informed, Activated Patient=
= Functional and Clinical Outcomes
Health System
3D"logo_icic-i"
The mo= del we chose to implement was the Chronic Care Model the purpose of creating  a more informed activated patien= t and a prepared proactive practice team working together in a partnership to improve functions and clinical outcomes.=   This model incorporates the paradigm shift from our current model = of heath care delivery that is problem-based designed to handle acute patient problems to a system that is prevention based to avoid long-term problems such as diabetes complications.  This however, is not done in isolation, it takes community resourc= es, self-management support (diabetes education classes), decision support (c= linical guidelines), Delivery system support which means designing the medical ca= re environment to support preventive care to accommodate the patients physic= al, psychological/psychosocial and educational needs (in our project we desig= ned diabetes “mini-clinics” or diabetes days and Clinical informa= tion systems, which in our study included chart audits to provide doctors with information as to what their diabetes care was like and also counseling t= hem to use their own data to make changes.&n= bsp; So as you can see, this is a multifaceted approach to behavior cha= nge involving many.  Using a multifaceted approach like this in a research study brings about many com= plexities in study design and interpretation, however testing just one component of= the model would not provide an accurate examination of its true effectiveness so…..
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Seattle 2007
nImplementation 12/2004
nProcess – Delivery System/Decision
§
Ident= ify before visit
Color = code chart
RNs review = new computerized flow chart
Highlighted reminders for Docs
Standing or= ders
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Seattle 2007
nImplementation 12/2004
nProcess – Delivery System/Decision
§
Ident= ify before visit
Color = code chart
RNs re= view new computerized flow chart
Highl= ighted reminders for Docs
Docs documen= t in chart using guideline embedded template
DEMP in the office
Stand= ing orders
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kxN5kysZlD5Jkw/5cgkpkiRpkoLxkgfZkj2ZkE4pkz3ZlEqJkU9ZkUYZGDdJkTlZkAo5lQPZkgEB ADs= ------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0100.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Chron= ic Care Model
Community
Health System
Organization of Healthcare
Decision Support
Delivery System Design
Clinical Information Systems
Self- Management Support
Resour= ces and Policies
Productive Interactions
Prepared, Proactive Practice Team
Informed, Activated Patient=
= Functional and Clinical Outcomes
Health System
3D"logo_icic-i"
The mo= del we chose to implement was the Chronic Care Model the purpose of creating  a more informed activated patien= t and a prepared proactive practice team working together in a partnership to improve functions and clinical outcomes.=   This model incorporates the paradigm shift from our current model = of heath care delivery that is problem-based designed to handle acute patient problems to a system that is prevention based to avoid long-term problems such as diabetes complications.  This however, is not done in isolation, it takes community resourc= es, self-management support (diabetes education classes), decision support (c= linical guidelines), Delivery system support which means designing the medical ca= re environment to support preventive care to accommodate the patients physic= al, psychological/psychosocial and educational needs (in our project we desig= ned diabetes “mini-clinics” or diabetes days and Clinical informa= tion systems, which in our study included chart audits to provide doctors with information as to what their diabetes care was like and also counseling t= hem to use their own data to make changes.&n= bsp; So as you can see, this is a multifaceted approach to behavior cha= nge involving many.  Using a multifaceted approach like this in a research study brings about many com= plexities in study design and interpretation, however testing just one component of= the model would not provide an accurate examination of its true effectiveness so…..
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------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0100_image042.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhigAOAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAgCH AAoAgAAAAP8A/wJZhI+By+0Po5yUqgrUxbz7DxraFJRliKaqZ56O1q7yTC/tmNxmxo9+D/wJg8Sh sYg8KpM6V6a5W0qT1Km1ilVCnSJd7Qv+NB+3sPlMikl26Lb7ubG85+j4ogAAOw== ------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0007.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seattle 2007
nPrepared and activated practice team
nAssigned RN diabetes coordinators by physician =
&sec= t;Continuity for patients over time
&sec= t;Get patients to the office
&sec= t;Follow-up
&se= ct;Patient advise (extension of the diabetes education model)
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0013.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seattle 2007
nImplementation of RN coordinators 2/2005
nLunch Training sessions with the Diabetes <= /span>Education and Management Program 
<= span style=3D'font-size:92%'>nUsed patient specific data from PPRNet
nList of patients with HbA1Cs over goal (>7%) generated for each responsible RN
<= span style=3D'font-size:91%'>nList of those = who are overdue for a visit
<= span style=3D'font-size:92%'>nRNs contact as= signed patients
<= span style=3D'font-size:91%'>nLetter explain= ing the system
<= span style=3D'font-size:91%'>nPhone call = ;
<= span style=3D'font-size:90%'>&sec= t;Make appointment
<= span style=3D'font-size:90%'>&se= ct;Get labs done before visit - standing orders for RNs
<= span style=3D'font-size:90%;visibility:hidden'>§
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0105.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Chron= ic Care Model
Community
Health System
Organization of Healthcare
Decision Support
Delivery System Design
Clinical Information Systems
Self- Management Support
Resour= ces and Policies
Productive Interactions
Prepared, Proactive Practice Team
Informed, Activated Patient=
= Functional and Clinical Outcomes
Health System
3D"logo_icic-i"
The mo= del we chose to implement was the Chronic Care Model the purpose of creating  a more informed activated patien= t and a prepared proactive practice team working together in a partnership to improve functions and clinical outcomes.=   This model incorporates the paradigm shift from our current model = of heath care delivery that is problem-based designed to handle acute patient problems to a system that is prevention based to avoid long-term problems such as diabetes complications.  This however, is not done in isolation, it takes community resourc= es, self-management support (diabetes education classes), decision support (c= linical guidelines), Delivery system support which means designing the medical ca= re environment to support preventive care to accommodate the patients physic= al, psychological/psychosocial and educational needs (in our project we desig= ned diabetes “mini-clinics” or diabetes days and Clinical informa= tion systems, which in our study included chart audits to provide doctors with information as to what their diabetes care was like and also counseling t= hem to use their own data to make changes.&n= bsp; So as you can see, this is a multifaceted approach to behavior cha= nge involving many.  Using a multifaceted approach like this in a research study brings about many com= plexities in study design and interpretation, however testing just one component of= the model would not provide an accurate examination of its true effectiveness so…..
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------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0105_image047.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhigAOAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAIAAgCH AAoAgAAAAP8A/wJZhI+By+0Po5yUqgrUxbz7DxraFJRliKaqZ56O1q7yTC/tmNxmxo9+D/wJg8Sh sYg8KpM6V6a5W0qT1Km1ilVCnSJd7Qv+NB+3sPlMikl26Lb7ubG85+j4ogAAOw== ------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0009.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seattle 2007
=
nPre-Project
n13 diabetes measures (first quarter 2004)
n3 above the median
n0 at the benchmark
nFirst quarter 2006
n9 above median
n4 above benchmark
n8 broke above UCL
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Seatt= le 2007
=
nInsurance Benchmarks – P4P
nJanuary 2004 - $3 per E/M service
nJanuary 2006 - $9 per E/M service ($50K increase)
n90% of Specialty Benchmark (.5 point) to 100% (1 point) in the 4 diabetic measures
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Seatt= le 2007
P4P
Benchmark
Microalb
Our Performance
Points Earned
Insurer 1
Insurer 2
PPRNet
50%
59%
64%
63%
63%
1
1
Insurer 1
Insurer 2
PPRNet
82%
83%
82%
73%
82%
1
0
HbA1C
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Seattle 2007
nTrickle Down Effect&= #13;
nHeart Disease/HTN= 3;
n72% of DM w/ HTN (2= 4% w/ HTN are DM)
n16% of DM w/ CHD (3= 6% w/ CHD are DM)
n54% of DM w/ Lipids (41% )
nObesity <= /div>
n31% dx of obesity&#= 13;
n41% of all w/ dx are diabetics
n&= #13;
n&= #13;
n<= span style=3D'mso-special-format:lastCR;display:none'>
------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/slide0085.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
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Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Chronic Disease Management by Jeff Minteer
Seattle 2007
=
nLessons learned
nCan improve chronic disease management in the middle of chaos
nMust involve the staff – show results =
nStaff time intensive
nSimple works
nStanding orders are important <= /div>
nNeed a cultural change to sustain the improvement
n=
n=
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n
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Seatt= le 2007
=
nLessons learned
nNeed to have accurate data
nOutcomes are slower to realize than process (Insurance companies can only measure process at this point!)
nBeware of the “pole vault” effect = ;
n=
n=
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n
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Seatt= le 2007
Pre-Project
(n=3D13)
1st Qua= rter 2006
(n=3D13)
4th Qua= rter 2006
(n=3D11)
Benchmark
0
4
0*
Median
3
9
2*
ABOVE UCL
0
8
2*
*MAJOR RECALCULATION
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Seatt= le 2007
nFuture Plans – Reenergize the slope
nTrain medical assistants to help with patient follow-up
nHire a Q/A nurse to = keep the “fire going”
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Seattle 2007
n“Lasting improvement in the management of chronic disease is only possible by effecting a systematic cultural change that involves an energized, adequately staffed medical team (including physician, clinical and clerical staff) with the assistance of outside specialty services. This effort can be financially prudent= in the long term by reducing the high cost of morbidity and in the short term through improved pay-for-performance reimbursement.”
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Click to edit Master text styles
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The model = we chose to implement was the Chronic Care Model the purpose of creating  a more informed activated patient= and a prepared proactive practice team working together in a partnership to impr= ove functions and clinical outcomes.  This = model incorporates the paradigm shift from our current model of heath care deliv= ery that is problem-based designed to handle acute patient problems to a system that is prevention based to avoid long-term problems such as diabetes comp= lications.  This however, is not done in isol= ation, it takes community resources, self-management support (diabetes education = classes), decision support (clinical guidelines), Delivery system support which means designing the medical care environment to support preventive care to accommodate the patients physical, psychological/psychosocial and educatio= nal needs (in our project we designed diabetes “mini-clinics” or diabetes days and Clinical information systems, which in our study included chart audits to provide doctors with information as to what their diabetes care was like and also counseling them to use their own data to make changes.  So as you can see, = this is a multifaceted approach to behavior change involving many.  Using a multifaceted approach lik= e this in a research study brings about many complexities in study design and interpretation, however testing just one component of the model would not provide an accurate examination of its true effectiveness so…..
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The model = we chose to implement was the Chronic Care Model the purpose of creating  a more informed activated patient= and a prepared proactive practice team working together in a partnership to impr= ove functions and clinical outcomes.  This = model incorporates the paradigm shift from our current model of heath care deliv= ery that is problem-based designed to handle acute patient problems to a system that is prevention based to avoid long-term problems such as diabetes comp= lications.  This however, is not done in isol= ation, it takes community resources, self-management support (diabetes education = classes), decision support (clinical guidelines), Delivery system support which means designing the medical care environment to support preventive care to accommodate the patients physical, psychological/psychosocial and educatio= nal needs (in our project we designed diabetes “mini-clinics” or diabetes days and Clinical information systems, which in our study included chart audits to provide doctors with information as to what their diabetes care was like and also counseling them to use their own data to make changes.  So as you can see, = this is a multifaceted approach to behavior change involving many.  Using a multifaceted approach lik= e this in a research study brings about many complexities in study design and interpretation, however testing just one component of the model would not provide an accurate examination of its true effectiveness so…..
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The model = we chose to implement was the Chronic Care Model the purpose of creating  a more informed activated patient= and a prepared proactive practice team working together in a partnership to impr= ove functions and clinical outcomes.  This = model incorporates the paradigm shift from our current model of heath care deliv= ery that is problem-based designed to handle acute patient problems to a system that is prevention based to avoid long-term problems such as diabetes comp= lications.  This however, is not done in isol= ation, it takes community resources, self-management support (diabetes education = classes), decision support (clinical guidelines), Delivery system support which means designing the medical care environment to support preventive care to accommodate the patients physical, psychological/psychosocial and educatio= nal needs (in our project we designed diabetes “mini-clinics” or diabetes days and Clinical information systems, which in our study included chart audits to provide doctors with information as to what their diabetes care was like and also counseling them to use their own data to make changes.  So as you can see, = this is a multifaceted approach to behavior change involving many.  Using a multifaceted approach lik= e this in a research study brings about many complexities in study design and interpretation, however testing just one component of the model would not provide an accurate examination of its true effectiveness so…..
25
The model = we chose to implement was the Chronic Care Model the purpose of creating  a more informed activated patient= and a prepared proactive practice team working together in a partnership to impr= ove functions and clinical outcomes.  This = model incorporates the paradigm shift from our current model of heath care deliv= ery that is problem-based designed to handle acute patient problems to a system that is prevention based to avoid long-term problems such as diabetes comp= lications.  This however, is not done in isol= ation, it takes community resources, self-management support (diabetes education = classes), decision support (clinical guidelines), Delivery system support which means designing the medical care environment to support preventive care to accommodate the patients physical, psychological/psychosocial and educatio= nal needs (in our project we designed diabetes “mini-clinics” or diabetes days and Clinical information systems, which in our study included chart audits to provide doctors with information as to what their diabetes care was like and also counseling them to use their own data to make changes.  So as you can see, = this is a multifaceted approach to behavior change involving many.  Using a multifaceted approach lik= e this in a research study brings about many complexities in study design and interpretation, however testing just one component of the model would not provide an accurate examination of its true effectiveness so…..
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charset="us-ascii" function LoadSld() { var sld=3DGetObj("SlideObj") if( !g_supportsPPTHTML ) { sld.style.visibility=3D"visible" return } if( MakeNotesVis() ) return runAnimations =3D _InitAnimations(); if( IsWin("PPTSld") ) parent.SldUpdated(GetSldId()) g_origSz=3DparseInt(SlideObj.style.fontSize) g_origH=3Dsld.style.posHeight g_origW=3Dsld.style.posWidth g_scaleHyperlinks=3D(document.all.tags("AREA").length>0) if( g_scaleHyperlinks ) InitHLinkArray() if( g_scaleInFrame||(IsWin("PPTSld") && parent.IsFullScrMode() ) ) document.body.scroll=3D"no" _RSW() if( IsWin("PPTSld") && parent.IsFullScrMode() ) FullScrInit(); =09 MakeSldVis(); ChkAutoAdv() if( runAnimations ) { if( document.all("NSPlay") ) document.all("NSPlay").autoStart =3D false; if( sld.filters && sld.filters.revealtrans ) setTimeout( "document.body.start()", sld.filters.revealtrans.duration * = 1000 ); else document.body.start(); } } function MakeSldVis() { var fTrans=3Dg_showAnimation && SldHasTrans() if( fTrans ) { if( g_bgSound ) { idx=3Dg_bgSound.indexOf(","); pptSound.src=3Dg_bgSound.substr( 0, idx ); pptSound.loop=3D -(parseInt(g_bgSound.substr(idx+1))); } SlideObj.filters.revealtrans.Apply() } SlideObj.style.visibility=3D"visible" if( fTrans ) SlideObj.filters.revealtrans.Play() } function MakeNotesVis() { if( !IsNts() ) return false SlideObj.style.display=3D"none" nObj =3D document.all.item("NotesObj") parent.SetHasNts(0) if( nObj ) { nObj.style.display=3D"" parent.SetHasNts(1) } return 1 } function ChkAutoAdv() { if(SldHasTrans()) SlideObj.onfilterchange=3DAutoAdv else AutoAdv() } function AutoAdv() { if(!IsWin("PPTSld") || !gUseSldTimings )return var sld=3DGetCurSld() if( (sld.mAdvDelay>0) && !parent.IsFramesMode() ) setTimeout("parent.GoToNextSld()",sld.mAdvDelay) } function GetObj(id) { if(g_supportsPPTHTML) return document.all(id); else return document.getElementById(id); } function SldHasTrans() { return SlideObj.style.filter !=3D ""; } function GetSldId() { return sId=3Dlocation.href.substring(location.href.la= stIndexOf('/')+1) } function HideMenu() { if( frames["PPTSld"] && PPTSld.document.all.item("ctx= tmenu") && PPTSld.ctxtmenu.style.display!=3D"none" ) { PPTSld.ctxtmenu.styl= e.display=3D'none'; return true } return false } function IsWin( name ) { return window.name =3D=3D name } function IsNts() { return IsWin("PPTNts") } function IsSldOrNts() { return( IsWin("PPTSld")||IsWin("PPTNts") ) } function SupportsPPTAnimation() { return( navigator.platform =3D=3D "Win32"= && navigator.appVersion.indexOf("Windows")>0 ) } function SupportsPPTHTML() { var appVer=3Dnavigator.appVersion, msie=3DappVer.indexOf("MSIE "), ver=3D0 if( msie >=3D 0 ) ver=3DparseFloat( appVer.substring( msie+5, appVer.indexOf(";",msie) ) ) else ver=3DparseInt(appVer) return( ver >=3D 4 && msie >=3D 0 ) } function _RSW() { if( !g_supportsPPTHTML || IsNts() || ( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) ) return var padding=3D0; if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6 cltWidth=3Ddocument.body.clientWidth-padding cltHeight=3Ddocument.body.clientHeight-padding factor=3D(1.0*cltWidth)/g_origW if( cltHeight < g_origH*factor ) factor=3D(1.0*cltHeight)/g_origH newSize =3D g_origSz * factor if( newSize < 1 ) newSize=3D1 s=3DSlideObj.style s.fontSize=3DnewSize+"px" s.posWidth=3Dg_origW*factor s.posHeight=3Dg_origH*factor s.posLeft=3D(cltWidth-s.posWidth+padding)/2 s.posTop=3D(cltHeight-s.posHeight+padding)/2 if( g_scaleHyperlinks ) ScaleHyperlinks( factor ) } function _InitAnimations() { animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined'; isFullScreen =3D (window.name =3D=3D "PPTSld") && !parent.IsFramesMode(); g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } } function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && (window.name=3D=3D"PPTSld") && !parent.IsFrames= Mode() ) || (event && event.keyCode=3D=3D32) ) { if( g_animUseRuntime && g_animMainSequence && g_animMainSequence.cangonex= t ) return; parent.GoToNextSld(); } } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"End of slide show, click to exit.", SCREEN_MODE=3D"Fram= es", gIsEndShow=3D0, NUM_VIS_SLDS=3D40, SCRIPT_HREF=3D"script.js", FULLSCR_= HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var gMainDoc=3Dnew Array(new hrefList("slide0102.htm",1,-1,1),new hrefList(= "slide0074.htm",1,-1,1),new hrefList("slide0091.htm",1,-1,1),new hrefList("= slide0094.htm",1,-1,1),new hrefList("slide0039.htm",1,-1,1),new hrefList("s= lide0110.htm",1,-1,1),new hrefList("slide0093.htm",1,-1,1),new hrefList("sl= ide0077.htm",1,-1,1),new hrefList("slide0098.htm",1,-1,1),new hrefList("sli= de0096.htm",1,-1,1),new hrefList("slide0003.htm",1,-1,1),new hrefList("slid= e0002.htm",1,-1,1),new hrefList("slide0044.htm",1,-1,1),new hrefList("slide= 0045.htm",1,-1,1),new hrefList("slide0088.htm",1,-1,1),new hrefList("slide0= 008.htm",1,-1,1),new hrefList("slide0097.htm",1,-1,1),new hrefList("slide00= 99.htm",1,-1,1),new hrefList("slide0049.htm",1,-1,1),new hrefList("slide010= 3.htm",1,-1,1),new hrefList("slide0048.htm",1,-1,1),new hrefList("slide0100= .htm",1,-1,1),new hrefList("slide0007.htm",1,-1,1),new hrefList("slide0013.= htm",1,-1,1),new hrefList("slide0105.htm",1,-1,1),new hrefList("slide0009.h= tm",1,-1,1),new hrefList("slide0109.htm",1,-1,1),new hrefList("slide0106.ht= m",1,-1,1),new hrefList("slide0081.htm",1,-1,1),new hrefList("slide0082.htm= ",1,-1,1),new hrefList("slide0083.htm",1,-1,1),new hrefList("slide0084.htm"= ,1,-1,1),new hrefList("slide0022.htm",1,-1,1),new hrefList("slide0085.htm",= 1,-1,1),new hrefList("slide0086.htm",1,-1,1),new hrefList("slide0012.htm",1= ,-1,1),new hrefList("slide0087.htm",1,-1,1),new hrefList("slide0112.htm",1,= -1,1),new hrefList("slide0107.htm",1,-1,1),new hrefList("slide0071.htm",1,-= 1,1)); function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) { var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix(); function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') { href=3Dnew String(document.location.href) Start=3Dhref.indexOf('!')+1 End=3Dhref.lastIndexOf('/')+1 if (End < Start) return href.substring(0, Start) else return href.substring(0, End) } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() { if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else return gCurSld } function GetNumSlds() { if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; PPTSld.location.replace(MHTMLPrefix+obj.mSldHref) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 PPTSld.location.replace(MHTMLPrefix+href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('


' + ENDSHOW_MESG + '

') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); function ImgBtn( oId,bId,w,action ) { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } function TxtBtn( oId,oeId,action,chkState ) { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() { b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() { b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr= row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); 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charset="us-ascii" Chronic Disease Management by Jeff Minteer ------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
 No= tes
Slide Show
Outline
= = = = = = = = = = = = = = = = = = = = ------=_NextPart_01C7DC5B.E461D560 Content-Location: file:///C:/D08A14CD/JMinteerCDM_files/oledata.mso Content-Transfer-Encoding: base64 Content-Type: application/x-mso 0M8R4KGxGuEAAAAAAAAAAAAAAAAAAAAAPgADAP7/CQAGAAAAAAAAAAAAAAABAAAAAQAAAAAAAAAA EAAAAgAAAAEAAAD+////AAAAAAAAAAD///////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// //////////////////////////////////////////////////////////////////////////// ///////////////////////////////////////////////////////////////////////////9 ////DAAAAP7///8EAAAABQAAAAYAAAAHAAAACAAAAAkAAAAKAAAACwAAAA0AAAD+////DgAAAP7/ 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