Physician/CM team boosts diabetes documentation

IHI spurs ongoing team initiative

University Health Systems of Eastern Carolina in Greenville, NC, targeted diabetes as a major initiative in June of 1998. The Institute for Healthcare Improvement (IHI) in Boston invited the team to present its outcomes at the IHI National Congress, "Improving Care for People with Chronic Conditions," held Oct. 28-29, 1999, in Dallas.

"That’s how the case management aspect of my job started," says Sylvia English, clinical nurse specialist and certified diabetes educator at Pitt County Memorial Hospital, a part of the 750-bed system. "Until then, my job had been limited to inpatient diabetes education."

When team members got to where they felt they could take on some diabetes case management, "some of us got together and set up a format," says English. "Little by little, as word is getting out, we have begun to get some referrals. The idea is catching on among the physicians." If a physician sees a patient with multiple comorbidities and decides he or she can’t address all the patient’s needs, the physician refers the patient to case management. (See chart showing the referral process, p. 20.) English is currently following eight patients who have been referred to her by their attending physicians.

The project is just beginning, so the team has no final outcomes yet, but so far, self management plan documentation has increased from 34% to 81%; smoking cessation counseling went from 4% to 60% and nine people have quit; and microalbumin screening went from 65% to 74%.

English says the team owes the project’s success to these elements:

• sharing clinic-specific data with staff;

• creating a dedicated work group;

• setting specific criteria for case management services;

• integrating efforts across the system;

• using available resources.

Barriers have included a lack of information technology, geography, rural practice settings, and — last but not least — the flood of the century that took place in October 1999.

For more information, contact Sylvia English, clinical nurse specialist and certified diabetes educator, University Health Systems of Eastern Carolina (Pitt County Memorial Hospital), Greenville, NC. Telephone: (252) 816-5136. E-mail: Senglish@Pcmh. com.