Patient-centered medical homes (PCMHs) are an effective way to help care for patients with chronic diseases such as diabetes, and placing care managers in them further improve patient outcomes for high-risk diabetes patients, according to a study conducted at Joslin Diabetes Center, an affiliate of Harvard Medical School.
Researchers compared different models of care management and how they impacted diabetes outcomes in three practices with 25 primary-care PCMHs. The kind of care managers varied among the sites: some were nurses or nurse practitioners, while others were social workers or medical assistants.
Researchers evaluated performance based on how well patients fared in the ABCs of diabetes: A1C, blood pressure and cholesterol level. Mean baseline data was determined for each site for the percentage of patients achieving A1C levels less than 7 percent, blood pressure less than 130mg Hg and low-density lipoprotein levels less than 100mg/dl.
Key findings from the study includes the following:
- The practices that demonstrated the greatest diabetes improvement were those with more patient-centered care manager duties, better use of the electronic medical record (EMR) for messaging and patient tracking, and stronger integration of the care manager into the care team.
- Practitioners and patients preferred embedded nurse care managers focusing wholly on the patient, particularly for the highest risk patients.
- The centers that ranked in the lower tertile for patient achievement of goals spent more of their time on administrative or supervisory duties.
- The managers in the lower ranking centers either did not have access to an EMR or felt the EMR was not user friendly.
- A greater amount of interaction between physicians, office staff and the care managers was associated with better outcomes.
Care management involves concentrating services where they are needed the most; around high-risk individuals in an effort to reduce costs, the study says. It is traditionally done over the telephone by registered nurses employed by insurers, but can be used in both community and primary care settings.
Source: Joslin Diabetes Center, January 21, 2014
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