Control charts help CMs track variance

Self-monitoring tools boost patient awareness

Case managers have long recognized the value of patient self-monitoring tools for chronic disease management. One tool that quickly identifies problems with a patient's disease management plan is a simple control chart, says Suzanne Powell, RN, BSN, CCM, director of case management and continuous quality improvement for the Health Services Advisory Group, a peer review organization in Phoenix.

"Control charts include an upper and lower control levels and statistical mean for a given value, such as blood sugar for diabetics or peak flow measures for asthmatics," she explains. Charts must be individualized for each patient, according to individual norms.

Case managers should work with the patient's physician to determine appropriate upper and lower limits for each patient, she says. In addition, case managers can set upper and lower limits using national benchmarks.

Charting useful in many chronic illnesses

"When patients self-monitor, they figure out sooner what behaviors are in their best interest. They can look at their own trends and see where the little dots go up and down indicating changes in their personal data," Powell says.

Further, self-monitoring allows patients to identify "common causes" and "special causes" of variation. "A normal cause falls inside the upper and lower limits. These variations reflect expected variation and show stability in the disease management plan. Special causes fall outside the upper or lower control limits and indicate unexpected variation, which indicates an inherent problem in the disease manage ment plan."

Powell suggests case managers use control charts to monitor the progress of a wide variety of chronically ill patients. "I can see control charts used by congestive heart failure patients to monitor fluctuations in their weight," she says.