Primary Care Center
Jason Worcester, MD
Shapiro Ambulatory Care Center
725 Albany Street
Boston, MA 02118
Tel: 617-414-4190
Fax: 617-414-9105
E-mail: Jason.Worcester@bmc.org
Assistant Professor of
Medicine
Boston University School of
Medicine
September 11, 2013
Dear Clinical Quality Awards Committee:
I am writing this letter for my enthusiastic support of the Diabetes Team in General Internal Medicine
nomination for the Award for Clinical Quality Improvement. The team leader is Karen Lasser, MD, MPH. Team
members include Jennifer Siegel, MD, Jim Danielson (process improvement specialist), Carmen Teso, RN,
Alexia Rojas (Practice Support Center), Megan Bergstrom, PharmD, Dan O’Shea (patient navigator), Roberta
Capelson, NP (Endocrinology) and James Rosenzweig, MD (Endocrinology).
The Diabetes Team has been involved in an innovative multidisciplinary project to deliver team based care to
primary care patients with poorly controlled diabetes. Straying from traditional care models, the team identifies
high risk patients using a newly formed patient registry. These patients are then discussed in a team meeting
format. Using individualized care that best fit each patient, care is delivered in a variety of methods. These
methods include individual visits, outreach calls by the nurse, counseling by a pharmacist, and real time
consultation by Endocrinology just to name a few. A key feature is that all team members, spanning many
disciplines and departments at Boston Medical, participate in the care of each of these patients. It is truly a team
effort.
The results of the Diabetes Team have been remarkable in such a short time. There have been significant
improvements in the control of these patients’ diabetes when compared to other diabetic patients in the practice.
The clinical outcomes have been impressive but I feel that the team based approach that has come out of the
efforts of the team is most notable. The Diabetes Team initiatives have demonstrated the effectiveness and
importance of team based care in an ever changing health care environment.
The Diabetes Team in General Internal Medicine has been a model project. The success of this program has
exemplified clinical quality, team based care, multidisciplinary coordination, patient centeredness and
innovation. I expect this to be a model for other project in the Primary Care Practice and in other practices at
Boston Medical Center.
Sincerely,
Jason Worcester, MD
Associate Medical Director, Shapiro Adult Primary Care