team approach to diabetes management · 2015-07-17 · team approach to diabetes management melanie...
TRANSCRIPT
![Page 1: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/1.jpg)
Team Approach to Diabetes Management
Melanie Batchelor Marget Blekfeld-Sztraky
Janice Lazear
![Page 2: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/2.jpg)
The Diabetes Care Team
ADA and AADE • Diabetes is complex • Team management endorsed as the ideal model for the delivery of care for people with diabetes • The core membership should reflect the basic requirements of diabetes treatment: nutrition, medication, self-monitoring, and self-management.
![Page 3: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/3.jpg)
Members of the Interdisciplinary Team
Team Members • Educators • Nurses • Dieticians • Providers • Pharmacists • Behavioral health
specialists • Case Managers • School Nurses • Dentists and hygienists
Team Members • Podiatrists • Exercise Physiologists • Ophthalmologists • Specialists • Maternal-child care • Gerontology
• Community Health Workers
![Page 4: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/4.jpg)
The Diabetes Care Team
• Comprehensive diabetes care program • Based on standards of care • Evidence-Based • Outcome focused
![Page 5: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/5.jpg)
![Page 6: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/6.jpg)
Elements of the Interdisciplinary Team
• Shared leadership with common goals • Shared professional identity • Collaborative, rather than consultative relationships
among members • Shared leadership • Mutual problem-solving • Open communication • Team cohesiveness
![Page 7: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/7.jpg)
Requirement for an Effective Team
• The commitment and support of organization leadership
• The active participation of the patient and health care professional team members
• Ways to identify the patient population via an information tracking system
• Adequate resources
• Payment mechanisms for team care services
• A coordinated communication system
• Documentation and evaluation of outcomes and adjustment of services as necessary
• National Diabetes Education Program http://www.ndep.nih.gov/media/NDEP37_RedesignTeamCare_4c_508.pdf
![Page 8: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/8.jpg)
Advantages of a Team Approach
• Reduces risk factors for T2DM • Improves diabetes management • Lowers the risk for chronic complications
![Page 9: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/9.jpg)
Delivery Care Models
Chronic Care Model
• The health system–culture, organizations, and mechanisms to promote safe, high-quality
care
• Delivery system design–for clinical care and self-management support, including team
care
• Decision support–based on evidence and patients’ preferences
• Clinical information systems–to organize patient and population data
• Self-management support–to enable patients to manage their health and health care
• Community involvement–to mobilize patient resources •
![Page 10: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/10.jpg)
The Medical Home Model
• Team approach with the patient at the center • Prevention • health information technology, • coordination • of care • shared decision making among patients and their health
care team
![Page 11: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/11.jpg)
The Healthy Learner Model
• Extends the Chronic Care Model to include school nurses • The goal is to maintain student health in the school setting • Leadership involving communities and school districts
![Page 12: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/12.jpg)
Successful Teams
• Patient/family central team member • Healthcare professionals • Complementary skills • Common goal and approach • Composition of teams may vary
![Page 13: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/13.jpg)
Nontraditional approaches used by teams
Shared Medical
Appointments
Increases Access to
Care Group
Education Telehealth
![Page 14: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/14.jpg)
Team Care Accomplishments
Team care improvement was found to improve one or more of the following: • Glycemic, lipid, and blood pressure control • Patient follow-up • Patient satisfaction • Risk for diabetes complications • Quality of life
![Page 15: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/15.jpg)
Six Team Building Steps
Ensure the commitment of leadership • Meet with primary care providers • Administrators • Payment specialists • Include key stake holders in planning
![Page 16: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/16.jpg)
Identify Team Members
• Invite potential team members to commit to being a member of the team • Clarify roles • Ensure mutual respect • Establish a common vision
![Page 17: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/17.jpg)
Identify the Patient Population
• Demographics • Diabetes types • Complications • Health care utilization patterns
![Page 18: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/18.jpg)
Assess Resources
• Space
• Equipment
• Supplies
• Support staff
• Education materials,
• Support groups
• Follow-up services
• Community resources
• Funding/payment mechanisms
• Home care services
![Page 19: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/19.jpg)
Assemble Tools
• standards of care • Treatment guidelines • protocols • Algorithms • education materials • flowcharts • Standing orders • Chart stickers, and other recording and reminder systems
![Page 20: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/20.jpg)
Develop a System for Coordinated, Continuous High-quality Care • Define the team:
• Philosophy • Goals • Objectives
• Information system • Identification • Data collection • Ongoing assessment • Monitoring performance measures
• A1C, blood pressure, lipids • Patient satisfaction • Quality-of-life indicators
![Page 21: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/21.jpg)
Determine the Structure and Scope of Services
Screening Preventative services Medical care DSME Counseling services Case management Community Outreach
![Page 22: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/22.jpg)
Evaluate Outcomes and Adjust as Necessary
• Databases – evaluate the outcomes of team care • Audit findings • Utilization data • length-of-stay • Emergency room visits • Total dollars spent can help evaluate outcomes of team • Quality measures • Patient satisfaction
![Page 23: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/23.jpg)
Maintaining a Successful Team
• Promote patient satisfaction, quality of life, and self-management • Promote a community support network • Maintain team coordination and communication • Provide follow-up • Use health information technology
![Page 24: Team Approach to Diabetes Management · 2015-07-17 · Team Approach to Diabetes Management Melanie Batchelor Marget Blekfeld-Sztraky Janice Lazear . The Diabetes Care Team ADA and](https://reader034.vdocuments.us/reader034/viewer/2022042419/5f36079f127a154d85039f3b/html5/thumbnails/24.jpg)
Questions?