Page 3 - FOCUS NOVEMBER 2107

THE CHRISTIANA CARE WAY
To make an impact on diabetes in our community, we serve together
By Vinay Maheshwari, M.D., Vice Chair, Department of Medicine, and Associate Physician Operations Leader, Acute Medicine Service Line
We’re in the midst of a trailblazing initiative at Christiana Care to impact
diabetes, a collaborative effort that will improve the health of our neighbors and colleagues.
This work is an exciting aspect of this year’s Annual Operating Plan, to focus on one, specific disease across service
lines. It’s also The Christiana Care Way in action, creating innovative, effective systems of care that provide value to patients and our community.
By approaching diabetes in a collaborative, comprehensive way, we will achieve our strategic goal to improve care standardiza- tion and outcomes. This work also offers us an opportunity to create a framework for the future, replicating interventions and partnerships to address other disease conditions that lead to frequent readmission, such as COPD and heart failure.
It’s my privilege to co-chair the Diabetes AOP Steer with Francis Gott III, MBA, RRT, director of the Primary Care Community Medicine Service Line. As team leaders, we can share insights on caring for patients from both the acute and primary care perspectives. The steer is diverse, with representatives from many disciplines and areas of expertise.
Our work, and the work of many exceptional colleagues, will make a meaningful impact on the health and well-being of thousands of neighbors and their loved ones.
In Delaware, 12 percent of the population is diabetic, slightly higher than the national average. That number is expected
to increase to 18 percent by 2030. At Christiana Care, 2,700 employees — about 25 percent — have diabetes or prediabetes, a precursor of the disease.
Diabetes is a serious health problem that impacts people’s livelihoods, longevity and the quality of their lives. The disease increases the risk of stroke, heart failure, heart attack and renal failure that requires dialysis. It contributes to neuropathy and foot ulcers, the most serious of which can result in amputations.
Diabetes impacts our patients across the board. It is a factor in surgery and recovery from surgery. It can contribute to negative outcomes for pregnant women and their babies. It affects
daily life.
That is why we are taking a comprehensive approach to helping people with diabetes to achieve optimal health. As an organiza- tion, we are aligning to carefully leverage our resources and part- nerships. As colleagues, we stand together in our common goal.
It’s a big task that requires a multipronged strategy, including patients, providers and community educators. The metrics we develop from this initiative play a vital role in establishing a guide toward improving care.
To that end, we are developing strategies for organizing clinical decisions and patient engagement tools. We are intent on getting information to our providers so we can close gaps, effectively and consistently. Our goal is to increase the number of patients who are diagnosed with diabetes so we can get them the care they need to lead the healthiest lives possible.
We are harnessing technology to make care more accessible and efficient. When patients are hospitalized, a glycemic care model gives our providers full awareness of where blood-sugar levels are. We are working on a seamless, effective plan for periop, with primary care and an endocrinologist partnering to optimize care before and after surgery. On the ambulatory side, an EMR health maintenance application lets us know when a patient is due for an eye exam.
A clinical pathway for diabetes guides doctors on how to treat patients based on their individual needs. A software tool helps us to understand how patients make the behavior decisions
they do and how we can respond to that. Point-of-care testing allows us to get results while the patients are in the office. We are collaborating with the Lab to make that happen.
Nutritionists and dietitians play an important role in managing diabetes. We are looking at ways we can better embed them into the primary care setting so patients can fully understand what they are eating and the impact of their diet on their health. Visit- ing nurses are monitoring and educating patients in their homes.
We aren’t just waiting for patients to come to us. We are engaging the community to break down barriers of culture and language to ensure that everyone who needs care receives it.
These are only a few examples of ways we will improve care and outcomes for diabetes patients. There is much more to come.
By working together, we reduce the redundancies that occur when we work in silos. We learn from one another. We serve together. ●
NOVEMBER 2017 FOCUS • 3