According to the Centers for Disease Control and Prevention, more than 100 million U.S. adults have diabetes or pre-diabetes – nearly 50% of the adult population.
Diabetes is a chronic condition that affects the way the body metabolizes glucose, the medical term for blood sugar. In diabetes, glucose either resists the effects of insulin – a hormone that regulates the movement of sugar into your cells – or doesn’t produce enough insulin to maintain normal glucose levels.
The Diabetes Integrated Practice Team at ChristianaCare is doubling down to try to get ahead of problems and identify them before they become even more troubling.
In a new electronic diabetes care management plan, “all pertinent data points are now available to all of a patient’s providers within the health system, for both inpatient and outpatient use,” said James Lenhard, M.D., an endocrinology specialist and a leader in implementing the program.
A data-driven approach
As the initiative advances, more information is becoming available a glance for inpatient settings, including patients’ weight, their last blood glucose numbers, when they last ate, and recommended insulin dosages based on that data, using evidence-based guidelines.
In caring for multiple patients on a hospital unit, providers can use a dashboard to track their status and be able to more efficiently and effectively manage each person’s blood glucose levels during their stay.
“This way, everyone sees the same information and gets the same alerts, all through a patient’s electronic medical record,” Dr. Lenhard said.
It also helps provide seamless care for patients once they are discharged from the hospital, he said. “Whether they are seeing their primary care physician or a specialist, that provider will have access to the latest information and advice for moving the patient in a healthy direction.”
A big lens on a growing problem
“Diabetes has become such a dramatically large problem that standardization of care for diabetes has become a nationwide focus,” said Dr. Lenhard.
At ChristianaCare, the standardization of care initiative in diabetes management reaches across inpatient and outpatient settings.
“We’re really trying to make sure we focus on the full continuum of diabetes care for the patient, whether they’re inpatient or ambulatory,” said Karen Anthony, MS, a health education specialist and director, Specialty Practice Operations.
For the inpatient setting, there is a strong focus on monitoring and addressing blood sugar levels, Dr. Lenhard said. Blood sugar abnormalities are responsible for worsening of the disease, increased length of hospital stay, and even death.
“Creating easy-to-access data sets will help us treat the patient to the best of our ability while they are in the hospital,” he said.
Initiatives to standardize outpatient care have been in progress for quite some time and have made some long-term differences in diabetes care and management.
Problem-solving to halt diabetes
ChristianaCare is part of a nationwide effort to identify pre-diabetes in an attempt to reverse it before it progresses to actual diabetes.
The health system offers diabetes education classes and nutrition education classes to complement regular physician visits.
“We’re making sure providers are using the same set of education tools with the patients so that, regardless of what practice they go to, what physician they see, they will be getting the same message,” said Anthony.
Another major focus is health equity. “There are patients who are particularly vulnerable to uncontrolled diabetes because of barriers they face in health care access, transportation to services and health literacy,” said Marina Zeltser, M.D., MBA, quality and safety officer, Primary Care and Community Medicine.
“We work with our patients to break down barriers they may have in accessing specialists,” she said. This could mean being connected to an endocrinologist or to an ophthalmologist for a retinopathy screening.
“Through partnerships with endocrinology and ophthalmology we’re really improving access and helping to facilitate care for patients with diabetes,” Dr. Zeltser said.
One initiative involves a virtual connection between a primary care practice and an endocrinologist. The endocrinologist supports the primary care practice with regular conference calls and ongoing sharing of information. This way, if a patient sees only the primary care provider, that individual will be equipped to treat the patient, having a full understanding of the patient’s needs.
Moving the needle on A1C
CareVio, ChristianaCare’s nationally recognized care management program, helps identify barriers to diabetes care throughout our communities, creating targeted solutions to help patients achieve better health outcomes.
“Leveraging the expertise of the CareVio team members, in collaboration with primary care physicians and endocrinologists, has proven effective for patients in our population with diabetes,” said Janine Jordan M.D., CHQCM, FACP and medical director for CareVio.
“Since September 2018, CareVio has identified more than 1,500 community members as high risk for diabetes with an A1C (blood sugar level) greater than 8.5% — while a normal A1C level is 5.7% or below,” said Dr. Jordan. “Through a standardized approach to diabetes case management, we reduced A1C levels in those community members to less than 8.5%.”
By using virtual tools such as secure text messaging, video conferencing and blood sugar monitoring, CareVio has helped community members improve their A1C levels, which can prevent illness and hospital visits equaling $2.5 million in health care costs.
“With care standardization, we take an interdisciplinary approach to caring for patients with diabetes,” said Dr. Lenhard. “Everyone plays a different role, with a cohesive approach. Diabetes is a progressive disease, so having every player on the team is important at every stage.”