The Chronic Care Model in DSMT: Program and Policy Changes

Thursday, August 11, 2005

Breakout Session

Speaker
Sharlene Emerson, MSN, CRNP, CDE

Reported by Joelle Escoffery, PhD

The Chronic Care Model (CCM) is an approach to healthcare delivery that is more appropriate for the delivery of diabetes care than the traditional acute model. The CCM includes 4 components: self-management support, delivery system design, decision support, and clinical information systems. This model has been used by the University of Pittsburgh to bring diabetes education to a primary care setting.

There are a number of benefits to bringing diabetes education to the point of primary care. First, it improves access for patients. Additionally, it improves communication between the patient and the physician. Putting an educator in primary care also moves one step closer to implementing a team approach to diabetes care, as the educator and physician are in the same location. This strategy also allows education and management to be more closely linked.

When attempting to place an educator in a primary care setting, the University of Pittsburgh used a specific strategy. First, they identified a physician with whom they wanted to work and identified a site where the educator would see patients. Following that, the program was introduced to the staff at the site. Next, the frequency of educator visits was determined. The physician and staff then were educated about scheduling and the referral process for diabetes educators. The program itself was designed to meet the American Diabetes Association criteria for recognition. Prior to the first educator visit, informational fliers were posted explaining the new service. Decisions had to be made regarding the structure of the diabetes education (eg, group setting, individual setting). Next, data had to be collected for recognition so that it could be obtained. Lastly, a contract with the primary practice for payment of educator services had to be negotiated.

In spite of this detailed action plan, a variety of challenges arose in the process of introducing a diabetes educator into the primary care setting. First, the staff had some difficulty understanding the role of the newly developed educator position. Numerous challenges related to scheduling were identified, many of which can be avoided if the educator is put into the scheduling template for the practice. Accessing records may be problematic, as every office uses a slightly different system (eg, paper, electronic, or some combination of the 2). Charting, record keeping, storage of supplies, IT issues, and office communication when the educator is out also posed a challenge to the process of implementation. Lastly, issues related to billing and reimbursement continue to be a struggle as policies continue to change and evolve.

Although the process of introducing an educator into a primary care setting is a difficult one, it is a critical strategy to help patients get the access to diabetes care that they need to optimally manage their condition.