MODELS FOR PRACTICE
FOCUS
AREA: DIABETES
Program Name:
Location:
Healthy People 2010 Objective: 5
Web Address: http://www.taoshospital.org
The Holy Cross Hospital (HCH) Diabetes
Self-Management Program (DSMP) is a participant in the NMMRA (New Mexico
Medical Review Association) Diabetes Collaborative. HCH DSMP offers four
curriculum visits covering 15 content areas from the National Standards and an
integration of community specialists, at no cost to the patients, to provide a
weekly exercise class, bimonthly coping skills education, a monthly diabetes
support group, and annual foot exams. HCH DSMP also has an electronic patient
registry using the DEMS-Lite software. Currently, the Diabetes Self-Management
Program at
Blueprint: Susan Kargula, RN, MSN, CDE
(Certified Diabetes Educator) began the Diabetes Self-Management Program in
1992 at Holy Cross Hospital as one of the hospital’s community wellness
programs. HCH DSMP serves the rural
area in northern
Grant awards have made it possible for weekly
exercise classes, bimonthly coping skills education, a monthly diabetes support
group, and annual foot exams to be offered to patients at no cost by a
community specialist. These community specialists include a medical director,
exercise physiologist, stress reduction specialist, and certified pedorthist (a
trained professional who specializes in designing or modifying footwear to
alleviate problems associated with injury or disease¾such
as diabetic foot). To be considered for the program, patients must have written
referrals through their primary care physician. If self-referred, a DSMP staff
member assists the individual in obtaining a written referral prior to the
initiation of services. The HCH DSMP staff also obtain registration
information, insurance prior authorizations, Medicare coverage, and ensure
coverage for uninsured patients through grants and hospital in-kind donations.
The education portion of the program is either provided individually, or in
some cases, in a group setting (exercise and stress reduction classes).
Making a Difference: As a participant in the NMMRA Diabetes Collaborative, HCH DSMP has a
strong quality improvement plan. Also, HCH DSMP has an electronic patient
registry using the DEMS-Lite software. The DEMS-Lite patient registry is used
to identify patients, proactively manage their care, and track outcomes for the
population. The program’s current goals include: Hemoglobin A1c
HbA1c < 7.0 percent, LDL cholesterol < 100 mg, documented
annual retinal eye exam, documented annual micro albumin, and documented annual
sensory foot exam. The outcomes are tracked electronically, and annotated run
charts are reviewed and posted monthly. In
the prior 12 months, HSH DSMP recorded 869 participant visits. The participant
distribution was 93 percent type 2, 6 percent type 1, and 1 percent gestational
diabetes.
HCH DSMP’s overarching goal has been to transfer
financial responsibility for education and management from the individual patient
to public resources. In the long-term, providing “free” care for such services
is not fiscally sound, nor does it ensure the viability of the program. It will
also diminish public motivation to politically assist DSMP in achieving payment
from governmental resources.
The program’s goal to provide 100 percent access to
excellence in diabetes management and support will be reached by the following
routes:
The program is presently in the planning stages of
providing a diabetes support group
(as funded by grant monies). In addition, because greater than 30 percent of
the population is uninsured, the program is in the planning stages of
developing a prescription assistance program that will provide patients with
diabetes medications at no cost. Collaborating with the hospital discharge
planning team, organizers are developing an inpatient diabetes education referral and education checklist to
ensure that all patients admitted to Holy Cross Hospital with a primary or
secondary diagnosis of diabetes will receive basic education and support before
discharge.
Beginnings: What became the Diabetes
Self-Management Program grew out of the current director’s pursuit of her
Masters of Science in Nursing degree when she was granted a mentorship with a
certified diabetes educator in 1992. She began to imbed this education into the
HCH community wellness programs, with the goal of preventing diabetes
complications in Taos County and surrounding areas. She began the diabetes
education program at HCH the same year, initially offering the program on lunch
hours at the hospital library with no source of funds.
Challenges and Solutions: Additional support for the
program was garnered through establishment of a fee schedule for the program in
1998. More important, by obtaining an American Diabetes Association “Certificate
of Recognition” in 2001, the diabetes education program became eligible for
Medicare reimbursement. Such recognition increased opportunities to obtain
grants to provide coverage to uninsured individuals with diabetes. The combined
effect was to enable the program to acquire its own space and to assume
responsibilities for registration and processing of charges for education.
Currently,
HCH DSMP can offer 100 percent access to quality diabetes education and support
regardless of an individual’s ability to pay. This excellent outcome was made
possible through efforts to obtain the ADA Certificate of Recognition and
grants awarded in the past year, as well as in-kind donations from the
hospital. HCH DSMP has become a “central” area for referrals from 21 Taos area
clinicians for diabetes education, resources, and support. In 2000, Diabetes
Clinical Care Guidelines were adopted by the HCH Primary Care Committee. At that time, the certified diabetes
educators requested and were approved to order lab work at their education
sessions that were recommended within the Clinical Care Guidelines (HbA1c,
annual micro albumin, and annual lipid profile). As a participant in the NMMRA Diabetes Collaborative, HCH DSMP has a very
strong quality improvement plan.
1397A
Weimer Rd.
Taos,
NM 87571
Phone:
(505) 751-5750
E-mail:
skargula@taoshospital.org