Diabetes Care Challenges Offer Hospitals Strategic Opportunities
Main Line Health has a diabetes process improvement team centered at Lankenau. The group includes endocrinologists, nutritionists, certified diabetes educators, nurse managers, and pharmacists. This team reviews order sets and disseminates guidelines to other campuses. It is important to evaluate prediabetes conditions, especially because of growing obesity rates in the country, and the team works on that, says Tavani.
Prediabetes is a condition in which blood sugar levels are higher than normal but not high enough to be considered type 2 diabetes.
Janet Wendle, RN, BSN, CDE, director of Main Line's education program, says she and other educators focus on encouraging patients to make lifestyle changes and keep up with their medications. The Centers for Disease Control and Prevention monitors records of obesity rates, and the states with the highest obesity rates also have the highest rates of diabetes, says Wendle.
Another factor in the increase of diabetic patients is because, in part, "this is a social issue, too. Patients are losing jobs and have no healthcare," says Tavani. "We are seeing an indigent population, and they repeatedly come to the hospital every couple of months. They run out of their diabetes medicine. We don't know if this is going to change," she says.
Main Line Health has a diabetes management program that includes individual consultations with a diabetes nurse specialist or diabetes dietician specialist, a 10-hour course in diabetes management, plus support groups and other resources.
At educational meetings with people with diabetes, Wendle says, "We talk about prediabetes, and when I ask them, 'How many of you have prediabetes?' usually more than half the hands go up." She warns them that they need to make changes, but understands that, for many, to make "behavioral changes, it's really tough."
Physician referrals for education are especially important. In a recent review of the system's program, of 100 people who were asked how they found out about the Main Line program, Wendle says 95 found out about it from primary care physicians.
Often, diabetes patients have comorbidities. Diabetes as a principal or secondary diagnosis can increase patient lengths of stay, which can decrease hospital revenue.
Success key No. 1: Multidisciplinary teams
As Mercy Saint Mary's Hospital developed its diabetes program, one of the first things officials did was to target efforts at admissions for those who knew they had diabetes and those who didn't.
The effort is a focus of Mercy Saint Mary's multidisciplinary diabetes operations team, the overriding team that focuses on inpatient and outpatient care. There are other teams that focus on diabetes as part of the hospital system, too, says Harnish.
Physicians, nurses, dieticians, and social workers comprise the operations team, which works with primary care physicians. "We invited the primary care physicians to come on the team so we're all talking the same language to the patient," says Harnish, the clinical nurse leader who oversees the inpatient diabetes program.
Mercy Saint Mary's also assembled a glycemic control team that works with other physicians in various service lines, such as cardiology and oncology, to coordinate care with respect to national protocols. The team includes specialists such as neurologists and vascular, cardiothoracic, gastrointestinal, and bariatric surgeons. The diabetes operations team handles blood sugar management protocols and education for patients.
"We work on diabetes or prediabetes throughout our healthcare system in a coordinated manner and ask 'How can we fill in any gaps we may have found?' " Harnish says. "A primary care physician may not know what to do further, having done all he or she can to help patients deal with their diabetes. They need to see a specialist."
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