Diabetes Nurse Case Management Training Program: Enhancing Care Consistent With the Chronic Care and Patient-Centered Medical Home Models

Abstract

M any patients remain at high risk for diabetes complications because of poor glycemic control.1–4 Case management, defined as “the assignment of authority to a professional (the case manager) who is not the provider of direct health care, but who oversees and is responsible for coordinating and implementing care,”5 is an effective intervention to improve glycemic control.6–8 The use of nurses as case managers (NCMs) for patients with poor glycemic control follows the Chronic Care Model (CCM) of collaborative care in that a proactive approach is undertaken by the health care team to improve outcomes.9 Similarly, the use of NCMs is aligned with the core principles of the Patient-Centered Medical Home (PCMH) model (e.g., enhanced access and coordinated and comprehensive care).10,11 However, research findings have not always shown that NCMs improve clinical outcomes.12 A recent evaluation of the Kaiser Permanente Northern California's care management program suggests that an important consideration for achieving success in clinical outcomes is ensuring that the NCM program encourages needed intensification of medication regimens for patients.13 However, finding and hiring nurses previously trained in glucose pattern management, including having the knowledge to make specific recommendations about adjustment of hypoglycemic medications, may present a barrier to health care organizations seeking to implement an effective NCM program. This article describes an internal training program for NCMs to improve glycemic control for patients in the Cleveland Veterans Administration (VA) health care system. This quality improvement (QI) training project allowed existing nursing staff members to become diabetes NCMs by providing them with the necessary skills to help address the growing gap between the care needs of patients with diabetes and the level of diabetes expertise available. The Cleveland VA operates 12 community-based outpatient clinics in northeast Ohio, …