Diabetes is the sixth leading cause of death by disease in the US. But caring for diabetic patients is remarkably simple. Most health care providers understand what needs to be done to keep diabetics well, but it is difficult and time-intensive to get the patient to participate in the process — and it’s easy for things to fall through the cracks. To care effectively for diabetic patients, a care management model must be put in place and followed consistently in order to keep diabetic patients healthy. Intermountain Healthcare’s system makes it easier for the health provider and the patient to do the right thing.
Diabetic Care Management at Intermountain Healthcare Diabetes is the sixth leading cause of death by disease in the US. But caring for diabetic patients is remarkably simple. Most health providers understand what needs to be done to keep diabetics well, but it is difficult and time-intensive to get the patient to participate in the process — and it’s easy for things to fall through the cracks. To care effectively for diabetic patients, a care management model must be put in place and followed consistently in order to keep diabetic patients healthy. Here’s how Intermountain Healthcare does it:
- When a diabetic patient is identified (in one of its 140 clinics, 21 hospitals, or among its 400,000 health plan members), this is noted in Intermountain’s advanced computerized electronic patient record.
- This electronic record then follows the patient wherever they go in the Intermountain system and identifies them to caregivers as diabetic.
- Patient education is provided in the physician office as well as in regular, consistent mailings. Care managers (typically nurses) are assigned to help individual diabetic patients and make outreach phone calls.
- Most of Intermountain’s hospitals and large clinics offer diabetic education classes as well as diabetic educators who visit the patients in their hospital room. There are multiple Diabetes Education Centers that have more than 20,000 patient visits each year.
- Patients are strongly encouraged and frequently reminded to get tests and screenings related to their diabetes. This helps them keep their blood sugar in control and avoid other complications.
- Intermountain’s health plan sends quarterly diabetes reports to physician offices listing the names, screening statuses, and lab results of diabetic patients. If patients have not been filling their diabetic medication prescriptions, the physician is notified so he can follow up with the patient. This report also allows physicians to see how his/her diabetes patient management compares to other physicians.
- Clinical teams of physicians, nurses, pharmacists, diabetes educators, and computer specialists meet monthly to measure and refine the process.
How does diabetic care at Intermountain compare to the U.S.? Two examples:
- Intermountain ranks above the national average in getting patients to do annual extensive HbA1c (blood sugar) testing, with 90 percent participating appropriately.
- Only 22 percent of Intermountain patients have poor HbA1c control compared to the national average of 29 percent. Poor control can contribute to a variety of other health problems.
It’s important to note that it’s unlikely any health care organization will achieve perfection. Much of this process depends on personal involvement by the patient, and some patients are more motivated than others.
Keywords:care teams, care management, care coordination, communication, diabetes, electronic medical record, EMR, evidence-based medicine, health information technology, Intermountain Healthcare, Salt Lake City, Utah, safety, treatment, value
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