Developing a Diabetes Management Service

Last year, the AAMC held its first-ever Readiness for Reform Innovations Challenge, to which academic medical centers  across the country submitted best practices. Three winning institutions were honored at the 2011 AAMC Annual Meeting in November, winning $5,000 each for their innovative programs. The Wing of Zock is featuring posts from two of the winners, as well as a post from the chair of the selection panel, in a series highlighting the successes and learning opportunities that came from developing these initiatives and entering the Innovations Challenge. The winning submissions, as well as all of the other entries, can be seen in their entirety on the AAMC iCollaborative.

By Kathie Hermayer, MD, Medical University of South Carolina

The development of MUSC’s diabetes management standardization dates back to 2003.My chairman of medicine at the time called me into his office and said that he needed an endocrinologist to lead a mission to improve diabetes care services at the hospital. There was no formalized program at MUSC for diabetes management: endocrine did their consult, internal medicine did their consult; everything was done separately. We wanted to build a service in the hospital where we directly served patients with diabetes concerns to improve patient care, which is how our Diabetes Management Service (DMS) and other hospital diabetes services were born.

South Carolina is ranked 5th in the nation for diabetes prevalence. One thing I realized as a practicing endocrinologist with 20 years of experience in a state with a very high diabetes rate is that when patients are in the hospital, they usually take their in-patient care as a template for what they should do at home. If their diabetes isn’t treated in the hospital, they regard it as a license not to take care of themselves when they go home.  Their attitude is, “Well, my doctors and nurses in the hospital didn’t look after me, so why do I have to look after me?” I’ve had several diabetes pump patients who have told me, “I don’t want to come into the hospital to get something done because I can take care of my diabetes better at home then they can in the hospital.”

Diabetes often can be overlooked in the hospital. Even though there are more hands-on initiatives from the federal government, diabetes management is still a drill-down initiative, which can be overwhelming for a large institution such as ours. We knew we had to start from the ground up. We now have four main standing hospitals, all within walking distance of each other, but trying to get the original all three hospitals on the same page initially was a huge undertaking. It’s probably a little easier for a smaller hospital to accomplish.

Our diabetes standardization initiative we have is intended to bridge the gaps to create a smoother transition between managing diabetes in the hospital and at home. Nurses can institute treatment for hypoglycemia rather than waiting for a physician to call back and with the OK. If a patient had a blood sugar of 19, we wanted to be able to treat right away.

The program has really evolved. In July of 2004 we started our diabetes management service, which was in-line with the hospital diabetes task force. We have about six or seven endocrinologists who attend on DMS rounds, and we see the patients who are difficult to control. We have standing agreements with surgery to can take over their patients’ diabetes management. We have four nurse practitioners and physician assistants who rotate with us and medical house staff and students who rotate with us as well. We see any patients we are asked to see over 18 years old. It was actually the idea of MUSC Hospital Medical Director Patrick Cawley to apply for the AAMC Innovations Challenge last fall. He thought with all of our efforts, we would have a reasonable chance at a favorable outcome.

The DMS and our other hospital diabetes management services have enhanced patient satisfaction. We do a lot of outpatient follow-up and have really tried to approach discharge management as well to take on new challenges and opportunities. This has been a great opportunity to educate our staff and engage our nurses. This program is just the groundwork for looking into the future of diabetes management. We fully expect the program to change and evolve based on upcoming challenges and patients’ needs; we will be ready for that when it happens.

—Kathie L. Hermayer, MD, MS, is a Professor of Medicine and Endocrinology in the Division of Endocrinology, Diabetes, and Medical Genetics at the Medical University of South Carolina (MUSC), Charleston, South Carolina. She is the Director for the Diabetes Management Service and Medical Director of Hospital Diabetes Services at MUSC. She can be reached at Hermayer@musc.edu.  

AAMC wants to hear about your programs that transform health care delivery! Submissions for the 2012 Innovation Challenge are due Friday, September 7, 2012, and are sought in these areas:

  • Innovative initiatives that serve the chronically ill;
  • Coordinated primary care delivery systems;
  • Redesign of care for specific medical conditions;
  • Innovations in graduate medical education training.

 Three institutional winners will be announced at the AAMC Annual Meeting in November and awarded $5,000 each. Questions? Email innovationchallenge@aamc.org.

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