Multidisciplinary Care Teams in Diabetes Management
What Are the Benefits of Using a Care Team?
Diabetes affects 9.3% of the US population and is associated with an estimated financial burden of $245 billion.<sup>1</sup> In caring for this costly, chronic condition, it is important for health care providers to consider all aspects of a patient’s life. Implementation of a diabetes care team ensures that all necessary behavioral, dietary, lifestyle, and pharmaceutical interventions are implemented, and can improve the overall quality of diabetes care.<sup>2</sup>
Positive Outcomes Associated With Care Teams
In a 2006 meta-analysis published in JAMA investigating the impact of strategic quality improvement on glycemic control among adults with type 2 diabetes, researchers found that the use of multidisciplinary care teams, shared care between primary care physicians and specialists, and effective case management led to reductions in HbA1c by at least 0.5%.<sup>3</sup> Additional positive outcomes of care team management include increased patient satisfaction, improved quality of life, fewer hospitalizations, decreased health care costs, and lower risks for diabetes complications.<sup>1</sup>
Multiple Models of Diabetes Care
The National Diabetes Education Program (NDEP) highlights 3 models that can be effective when caring for patients with chronic diseases like diabetes: the chronic care model, the medical home model, and the healthy learner model.<sup>1</sup> In the 2016 update of the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes2 the ADA notes that the chronic care model “has been shown to be an effective framework for improving the quality of diabetes care.” The model’s focus on collaborative, multidisciplinary teams provides care by those best equipped to handle chronic conditions.
Creating a Successful Care Team
Integration of health care professionals and families is the basis of a comprehensive care team for patients with diabetes, according to the NDEP. Team members vary based on the patient’s needs, the physician’s patient loads, and resources within the clinical setting,<sup>1</sup> but teams should always be coordinated by 1 key person. A diabetes care team may include physicians from a number of specialties, including podiatry, pharmacy, optometry or ophthalmology, psychology, and dentistry. Additional resources can be provided by dietitians, nurse educators, diabetes educators, case managers, social workers, and school nurses, home care nurses, and local community partners.<sup>1,4</sup>
Building the Care Team
The NDEP recommends that health care professionals follow a 6-step process for creating or expanding a patient care team.<sup>1</sup> 1) <b>Ensure the commitment of leadership</b> by choosing well-respected clinicians who will provide support to both patients and other team members. 2) <b>Identify team members</b> and clarify the role each person will serve. 3) </b>Identify the patient population,</b> including demographic characteristics and risk factors, complications, and comorbidities among patients. 4) <b>Assess resources.</b> Look for strengths and weaknesses among support staff, education materials, equipment and supplies, and home care services. 5) <b>Develop a system for coordinated, continuous, high-quality care</b> through team goals and objectives. Care teams should create secure information systems, accessible to all team members. 6) <b>Evaluate outcomes and adjust as necessary,</b> using analytic reports and pooled medical record audits, patient satisfaction and quality-of-life interviews, and clinical, behavioral, and financial outcomes.<sup>1</sup> For more information on these steps, visit the NDEP website.<sup>1</sup>
How to Keep the Care Team Successful
Maintaining a successful care management team is crucial for continued success. Promotion of patient satisfaction and community support networks lead to positive outcomes, including sustained diabetes self-management.<sup>1</sup> Coordination and communication among team members can be encouraged by the use of a multidisciplinary planning and documentation tool,<sup>1</sup> which clarifies responsibilities for all stakeholders and ensures continuation of care. Finally, regular patient follow-up and use of health information technology can minimize health risks through surveillance and intervention and prevent adverse events by initiating timely treatment.<sup>1,4</sup>
Non-Traditional Diabetes Care
Telehealth, shared or group medical appointments, and group education can improve patients’ access to their diabetes care team.<sup>1,4</sup> Typical shared appointments include 8 to 10 patients and take place as 1- to 2-hour appointments every 3 months.<sup>1</sup> While the success of this care model is dependent on active participation of all patients and caregivers who are present, generally positive results have been reported.<sup>1</sup> This care model has also been linked to increased provider efficiency.<sup>1</sup>
Key Messaging in Diabetes Management
All care team members can ensure continued patient care by reinforcing specific messages with their patients at each visit, such as the promotion of the ABCs of diabetes (HbA1c, blood pressure, cholesterol, and smoking cessation) through setting short- and long-term goals and providing resources.<sup>4</sup> Healthy lifestyle can be promoted by encouraging meal planning and suggesting different types of moderate-intensity physical activity, and can be reinforced by complimenting patients on steps they have taken towards achieving these goals.<sup>4</sup>
Are Diabetes Education Programs Cost-Effective?
Patient participation in diabetes education programs has been found to improve clinical outcomes, including fewer hospitalizations and lower health care costs. In 2 observational studies,<sup>5,6</sup> researchers determined that diabetes education programs can be linked to reduced health care costs. In the first study,<sup>5</sup> any type of educational diabetes visit was associated with $11,571 less hospital charges per person. The second study<sup>6</sup> reviewed commercial and Medicare claims from 2005 to 2007 and found that Medicare members who participated in diabetes education programs paid 14% less than those who were commercially insured.
Medicare and Private Insurance Coverage of Diabetes Education Programs
Both Medicare and private insurance companies will cover diabetes self-management education programs when provided by an educator who has been accredited by a diabetes education program, and diabetes medical nutrition therapy (MNT) when provided by a registered dietitian.<sup>1</sup> Payments for self-management diabetes education services can be received if the education program reaches certain standards set by the ADA or the American Association of Diabetes Educators (AADE).<sup>1</sup> Additionally, Medicare coverage extends to various tests, equipment, supplies, medications, and services for patients with diabetes and those at risk for diabetes.<sup>1</sup>
Caring for patients with diabetes is a challenge that requires cooperation across health care specialties. Evidence suggests that using a care team-based approach to diabetes management—incorporating clinician specialists across various disciplines—is a cost-effective way to provide high-quality, patient-centered diabetes care.1
Compiled by Lauren Biscaldi.
- National Diabetes Education Program (NDEP). Redesigning the health care team: diabetes prevention and lifelong management. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) website. Updated February 2013. Accessed November 15, 2016.
- American Diabetes Association. Standards of medical care in diabetes—2016 abridged for primary care providers. Clinical Diabetes. 2016;34(1):3-21. doi:10.2337/diaclin.34.1.3
- Shojania KG, Ranji SR, McDonald KM, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA. 2006;296(40):427-440. doi:10.1001/jama.296.4.427
- Rodgers P, Bennett Williams P, Frisch DR, et al. Working together to manage diabetes: a guide for pharmacy, podiatry, optometry, and dentistry. Bethesda, MD: National Diabetes Education Program. Published January 2016. Accessed November 16, 2016.
- Duncan I, Birkmeyer C, Coughlin S, Li QE, Sherr D, Boren S. Assessing the value of diabetes education. Diabetes Educ. 2009;35(5):752-760. doi: 10.1177/0145721709343609
- Robbins JM, Thatcher GE, Webb DA, Vladmanis VG. Nutritionist visits, diabetes classes, and hospitalization rates and charges: the Urban Diabetes Study. Diabetes Care. 2008;31(4):665-660. doi: 10.2337/dc07-1871
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