Diabetes program slashes costs by 68%
Convenient clinic makes a difference
The significant incidence of diabetes in the south Texas area gave Spohn Memorial Hospital in Corpus Christi good incentive to implement a diabetes disease management program. After a two-year study of 107 patients, the hospital has an even better incentive to keep such a program going.
The pilot diabetes program, designed with the help of Dallas-based E2M Health Service, cut health care costs an average of 68% per patient per year while the control group saw costs rise 45%. Hospital admissions dropped 33%, and length of stay declined 26%.
"We were seeing hospital visits and severe circulatory problems in diabetic patients that we knew could have been prevented," says Jan Kottke, Spohn's director of primary care services. "The costs were significant for the patients and the hospital. With this program, the patients are better equipped to manage their disease, and they're healthier as a result.
One unique aspect of the program and perhaps a key to its success was the establishment of a specially designed clinic that provides all necessary services, except for the physician, in one convenient location.
Program expanded counseling to year-long
Patients get regular lab work-ups including hemoglobin levels, attend group classes, and receive one-on-one counseling at the clinic. In the study, 69% of the patients experienced a reduction in their HbA1c level, averaging a 1.6 point reduction per patient.
"Improving the access to services makes a big difference," says Ed Barnwell, chief executive officer of E2M. "The environment is nonthreatening, and the care is customized." E2M is expanding that concept with other clients in New York to establish clinics in large food stores where patients are likely to shop.
Another key to the success of the program is the patient education component that turned the hospital's standard diabetes education from one week of classes to a year-long relationship between patient and provider. "Most of us have a saturation point for learning," Kottke says. "E2M stretches that time out, giving patients pieces of information they can handle and then assessing whether they've actually learned it."
A multidisciplinary team made up of the primary care physician, the specialist, a pharmacist, a nurse, and a lab technician works on an individual basis with each patient. Patients are seen at least every 90 days, more often if needed. They get frequent lab tests (cholesterol, blood pressure, and blood glucose) and foot checks that are recorded in the computer program and reported monthly to the physician. "We catch trends before they turn into complications," Barnwell says.
Because the patients get immediate feedback from their lab results, it's easier for them to see what they need to change. "If the numbers are good, the patient gets a sense of accomplishment that reinforces the need to continue good habits," Kottke says. the numbers aren't so good, patients know that too. The nurse can tell them that this result is a good example of how a habit like exercise can make a difference in their lives."
Nurse educators, community pharmacists, and lab technicians participating in the study received extensive training based on established references such as the American Diabetes Association's core curriculum for diabetes educators.
Each person was required to complete a three-month class including home study, weekly tests, and inservice sessions that covered such topics as patient assessment, communication skills, and use of the computer program that tracks each patient's care. At the end of the course, team members attended a two-day inservice session and were tested on their knowledge, patient assessment, and injection technique. "We basically teach them how to empower the patient," Barnwell says. "We meld components of traditional patient education with a proactive and progressive style."
The initial enrollment class gives patients and family members a chance to bond with each other and with the care team. Patients in the study were asked at that time to make a commitment to improving their own care for at least one year. A clinical pathway based on American Diabetes Association standards of care and the input of hospital physicians is customized for each patient.
Continuous follow-up and individual education sessions with the nurse educator or pharmacist ensure patients know how to care for themselves and how to spot warning signs. Spohn's existing 24-hour telephone service that allows patients to contact nurses immediately if needed was also available for the patients in the study.
E2M also established an advisory board made up of Corpus Christi physicians who established a consensus on protocols for patient treatment, Barnwell says. "The whole point of this program is to support the physician who doesn't have the time or the means to track patients this carefully so we need to make sure the physicians are involved from the beginning," he says. "This is not a cookbook approach. We are reporting information so the physician can make better-informed decisions."
For more information on diabetes disease management, contact:
Jan Kottke, Director of Primary Care Services, Spohn Memorial Hospital, 2606 Hospital Blvd., Corpus Christi, TX 78405. Telephone: (512) 902-4196.
Ed Barnwell, CEO, E2M Health Services, 14275 Midway Road, Suite 220, Dallas, TX 75244. Telephone: (972) 687-9052.
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