BG levels should be rechecked 1 to 2 hours after the insulin bolus is provided. Problem-based learning sessions were used to demonstrate implementation of guidelines into a plan of care. Ms.Lisa Chadha Results 2009; 360: 1283-1297. The objective of this study was to determine how CCM has been applied in US primary care settings to provide care for people who have diabetes and also to describe outcomes of CCM implementation. Fat people always develop type 2 diabetes eventually - this is not true. Tachypnea or Kussmauls respiration (deep and labored breathing due to underlying metabolic acidosis and a compensatory respiratory alkalosis drive) may reflect underlying acidosis. Developed the Vermont Diabetes Information System to collect clinical information and provide flow sheets, reminders, and alerts to physicians and their patients with diabetes. [A PRESENTATION ON: How do I view different file formats (PDF, DOC, PPT, MPEG) on this site? Simmons D, Weblemoe T, Voyle J, Prichard A, Leakehe L, Gatland B. Participants showed improvement in performance measures, such as initiating goal setting, receiving eye and foot examinations, seeking vaccinations, attaining blood pressure goals, and adhering to medication instructions, but they showed nonsignificant improvement in HbA1c. Tsai AC, Morton SC, Mangione CM, Keeler EB. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. Modest stress-induced hyperglycemia is common in pediatric ERs but BG levels above 300 mg/dL are considered unusual and may be a marker of severity of illness and poorer outcome.20 Underlying DM may not be present in the majority of cases. These assessments could enable health care administrators and professionals to determine how CCM could become further integrated into primary health care initiatives in diabetes. Lyles et al (23) found that the use of a secure e-mail connection and a smartphone to upload glucose readings via a wireless Bluetooth device allowed some participants to feel better connected with their nurse case manager. WebOur Commitment to Anti-Discrimination. BG levels in excess of 600 mg/dL will likely require a higher initial insulin dose. 2011; 17: 370-375. Laboratory results, self-reported dietary habits and health beliefs, patient satisfaction with clinic rated on scale of 1 to 10. Two studies (19,20) revised the health care system to redefine health care team roles (eg, nurses, instead of PCPs, became responsible for conducting foot examinations). MacLean CD, Littenburg B, Gagnon M, Reardon M, Turner PD, Jordan C. The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices. Providers need to place the level in the appropriate context (probable stress hyperglycemia, known type 2 DM, known insulin-treated or type 1 DM, known alternative cause of DM [steroids, post pancreatic surgery, chronic pancreatitis, etc. At the other extreme, in an insulin-resistant patient, BG levels may fall 5 to 10 mg/dL per unit or rapid-acting insulin can be used. Diabetes nurse case manager and motivational interviewing for change (DYNAMIC): Study design and baseline characteristics in the chronic care model for type 2 diabetes. For example, the Rockwood Clinic Foundation revised its mission statement to include fundraising for research and development in new methods of chronic care delivery, which has resulted in increased funding for training materials, glucometers, blood pressure monitors, and laboratories (20). Inclusion criteria specified that studies 1) be published after the formal inception of the original CCM (1999) (5); 2) use the original CCM (4,5) instead of the expanded CCM (7); and 3) describe CCM-based interventions to manage and treat diabetes in US primary care settings. CCM is used as the framework; laboratories provide daily data feeds; algorithms provide automatic test interpretation; fax and mail are used for providers not easily reached by electronic networks; reports are formatted for accessibility and usability by patients and providers. Prevalence of hypertension and its associated risk factors among school age c Case study hypertension presentation show, Ectodermal Dysplasia: a case report and overview, Case Report: Prostate Cancer/Septic Shock, Renal Tumour Angiomyolipoma - Bizarre Presentation. CCM group mean (SD) age, 69.7 (10.7) y; 50% male; 13% nonwhite; 50% less than a high school diploma; 44% income <$20,000/year. Process of diabetes care, metabolic and vascular risk factor control with a 10-year estimated risk of cardiovascular disease; cost of care; participants functional health status. Percentage improvement was calculated. Physicians and their patients were randomized to the control or intervention group (clustered randomization). Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. DM is often undiagnosed and has serious long-term complications, so it is reasonable to consider near universal BG testing in adults. It appears that you have an ad-blocker running. A low-cost decision support and information system based on the CCM is feasible in primary care practices, especially practices that lack sophisticated electronic information systems. 2001; 24(1): 131-153. Factors suggesting a need for higher insulin dosing than the starting protocol would be high body mass index (BMI > 35), features of insulin resistance (acanthosis nigricans on skin examination, known PCOS, steroid treatment, significant stress). Monthly support groups focused on foot care, healthful cooking and recipe modification, alternative treatments, and problem-solving skills. In patients with symptoms suggestive of hypoglycemia (mental status changes, sympathetic discharge symptoms such as diaphoresis, tremor, palpitations and/or tachycardia), it is also imperative to check a BG level. Click Now customize the name of a clipboard to store your clips. Significant changes in orthostatic pulse and/or blood pressure may provide evidence of volume depletion. Provided bilingual/bicultural community health workers services, including home visits, accompanying patients on medical visits, and telephone and in-person counseling and support. Rapley P, Davidson PM. Duckworth W, Abraira C, Mortiz T, et al. Diabetes days scheduled; on these days, a CDE was present in PCP offices. Hospital and PCP collaborations within the community, such as partnerships between the University of Pittsburgh Medical Center and western Pennsylvania community hospitals and PCP offices (12), provided greater access to funding, information systems, and administrative support for CCM implementation (11,12,16,17). Intensive versus Conventional Glucose Control in Critically Ill Patients. Glucocorticoid induced insulin resistance impairs basal but not glucose entrained high-frequency insulin pulsatility in humans. orthostatic changes in pulse and/or blood pressure), and no evidence of DM-related acute complications. Severe hypoglycemia (glucose levels < 40 mg/dL and/or with mental status changes and/or myocardial or cerebral ischemic symptoms) requires urgent management. Protecting People., National Center for Chronic Disease Prevention and Health Promotion. Physicians and patients were nonblinded, and outcome assessors and data analysts were blinded to allocation (n = 639). More public-private partnerships need to be developed between providers and community organizations to address barriers to care and explore culturally appropriate community-based services (eg, cooking classes, exercise programs, nutrition counseling, self-monitoring assistance) for underserved populations and neighborhoods. Developed protocol to provide clinicians with key clinical information for each patient visit. Another author (M.S.) interactive lectures Golovchenko I, Goalstone ML, Watson P, et al. Accessible to patients on a personal computer or a Nintendo Wii, it provided clinical reminders and patient performance summaries. 2011; 17(3): 404-411. Health system reorganization also helped to establish diabetes self-management training programs (12,16,17) that identified and intervened with patients at risk for developing complications (17) and improved clinical and behavioral outcomes (12,16). 30-Minute interactive group sessions focused on dietary choices, exercise, weight loss, and self-monitoring. Piatt GA, Orchard TJ, Emerson S, Simmons D, Songer TJ, Brooks MM, et al. Curr Treat Opt Neurol. Trained clinicians to treat patients to target blood glucose control and cardiovascular risk factors. WebBrowse our listings to find jobs in Germany for expats, including jobs for English speakers or those in your native language. The authors suggest avoiding initiation on insulin therapy in the urgent care setting. The 6 components (4,5) are 1) health system organization of health care (ie, providing leadership for securing resources and removing barriers to care), 2) self-management support (ie, facilitating skills-based learning and patient empowerment), 3) decision support (ie, providing guidance for implementing evidence-based care), 4) delivery system design (ie, coordinating care processes), 5) clinical information systems (ie, tracking progress through reporting outcomes to patients and providers), and 6) community resources and policies (ie, sustaining care by using community-based resources and public health policy). Patients with Type 1 DM who have taken basal insulin within 24 hours, those using an insulin pump or who have recently taken a bolus of rapidly acting insulin likely will require frequent blood glucose monitoring, too. However, insulin remain the medication of choice if acute treatment is needed. At the end of the study, nearly half of the centers patients with diabetes reached the target goal of an HbA1c less than 7.0. Practical clinical trial with 3 arms: interactive weekly automated telephone self-management support with nurse follow-up (ATSM), group medical visits with physician and health educator facilitation (GMV), and usual care; random assignment to groups (n = 339). Other classes of non-insulin glucose-lowering agents such as DDP-4 inhibitors or TZDs (pioglitazone) are likely best not started in the urgent care setting because of cost, complexity, and side-effect issues. WebGRAY, Prof Glenda MBBCH, FCP (Paeds) SA. We now know that stress hyperglycemia, left untreated, has been associated with longer hospital stays, higher rates of ICU admission, greater need for rehabilitation services at time of discharge, and higher mortality rates.4, The link between hyperglycemia and adverse outcomes is multifactorial. A 2- to 3-fold greater proportion of patients reached when DSME was available at primary care practices compared to hospital-based programs. If hyperglycemia is detected, then a decision can be made about whether treatment is required. Insulin-treated patients will often use rapid-acting insulin to treat hyperglycemia, so it is logical to provide similar therapy while in an urgent care center. Private practices divided into 3 groups: CCM, provider education only, and usual care. Another factor is patient waiting time. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Multilevel, cluster-design, randomized controlled trial (n = 382). Health Aff (Millwood) 2001;20(6):6478. 2008; 15: 1241-1247. STROKE The ICCC has a larger focus on supporting positive policy environments (ie, partnerships, legislative frameworks, human resource allocation, leadership, and financing) in community and health care organizations (33,37). Insulin is the logical choice for acute management. For older populations of chronic disease patients (the age group sampled in most of the reviewed studies), training programs on the use of digital technologies for diabetes self-management may reduce the anxiety and barriers to access that may currently exist (23,34). Medications were available at no cost to patients according to clinic policy and practices. Medical Outcomes Study Short Form 36. Looks like youve clipped this slide to already. Patient Assessment of Chronic Illness Care, short-form Test of Functional Health Literacy in Adults, Interpersonal Processes of Care for Diverse Populations, Summary of Diabetes Self-Care Activities Measure, Diabetes Quality Improvement Program diabetes self-efficacy measure, Short Form-12 instrument for quality of life. Blood glucose readings were remotely uploaded to providers for interactive feedback through a wireless Bluetooth device connecting a glucometer and a smartphone. Percentage of patients achieving goals for HbA1c, blood pressure, and LDL cholesterol. Hollingdal M, Juhl CB, Dall E, et al. Released in 1996 and featuring songs from Lynyrd Skynyrd, Waylon Jennings, Alabama, Tanya Tucker, and Hank Williams Jr, among others, this 32-minute, 11-song album was an album ode to NASCAR by some of country's biggest stars. J Clin Endocrinol Metab. The SlideShare family just got bigger. Luna B, Feinglos MN. Of 6 years of data in the diabetes registry, 5% aged <30 y, 39.7% aged 3064 y, 15.5% 65 y. Glycemic control; patient participation in activities. Future research could include a meta-analysis of data (27) from randomized controlled trials to evaluate the methodological quality of quantitative studies that have tested the effectiveness of CCM for managing diabetes. No more guesswork - Rank On Demand Cultural factors (eg, food preparation, views of illness) should be considered when designing, implementing, and evaluating DSME for these underserved groups (31). PCPs completed routine examination and assessed complications during each visit. Improving chronic illness care: translating evidence into action. an overview of Stroke a cardiovascular accident ( a neurological condition). Involving patients in exploratory focus groups to inform the development of assistive technologies can customize educational technology and address usability concerns among unique patient populations (35). We determined which of the 6 CCM components had been applied to each intervention and how the component(s) had been applied. Specialty expertise from a volunteer endocrinologist was consistently available by telephone or e-mail. Inzucchi RM, Bergenstal, JB Buse, et al. Inpatient Plant Based Nutrition: Review of the History and Challenges for Ap Case presentation on Myocardial Infarction, Sexually transmitted diseases (STDS) with nursing responsibilty, Management-Pregnancy-Uterine-Scar-SLCOG.pdf, Geriatric Oncology_ Treatment, Assessment and Management ( PDFDrive ).pdf, Rhinology - The New EPOS Guidelines for CRS - Prof Valerie Lund.pdf, No public clipboards found for this slide. We found that diabetes self-management education (DSME) generally improved psychosocial and clinical outcomes in patients with diabetes. Piatt GA, Anderson RM, Brooks MM, Songer T, Siminerio LM, Korytkowski MM, et al. Multilevel, cluster-design, randomized controlled trial (n = 119). Atlanta, GA: U.S. Department of Health and Human Services, Center for Disease Control and Prevention, 2011. JAMA 2002;288(14):17759. Tap here to review the details. NURSING NICE study investigators, Finfer S, Chitlock DR, et al. Used a self-management goal sheet to set patient goals, estimate patients confidence in achieving his or her goal from not confident to very confident, and check on goal adherence with a 2-week follow-up call by a resident. Click here to review the details. For example, Schillinger et al (15) found that weekly automated (prerecorded) tailored telephone calls from nurses were associated with improvements in interpersonal processes of care, physical activity and function, and slightly better metabolic outcomes (eg, HbA1c, blood pressure, cholesterol). Univariate analyses to determine differences between baseline and 12-month follow-up, paired, Patients in the CCM group had significant increases in blood glucose self-monitoring at 12-month follow-up (. Academic-affiliated primary care practices. Collaborative clinical information systems using disease registries and electronic medical records enabled multiple health care providers (eg, PCPs, nurse practitioners, nurses, CDEs, physician assistants, medical assistants) to review detailed reports on laboratory and examination results and identify lapses in diabetes care (eg, missed visits, laboratory appointments, and examinations). Healthy Aging 2.0: the potential of new media and technology. CDE provided individual diabetes counseling, including nutritional counseling. Note: Javascript is disabled or is not supported by your browser. Medications were reviewed in group setting; discussion focused on adherence. No significant differences in metabolic outcomes and coronary artery disease risk were found between control group and group receiving the virtual consultation. We did not conduct a meta-analysis because we did not have access to primary data, and the variability in study design did not allow us to pool data. WebThe U.S. Agency for Healthcare Research and Quality (AHRQ) created the Health Care Innovations Exchange to speed the implementation of new and better ways of delivering health care. Assuming a drop of 10 mg/dL per unit of rapid-acting insulin, that would predict the need for a bolus of 20 units of rapid-acting insulin to lower a BG level of 350 to 150 mg/dL. Adapting the chronic care model to treat chronic illness at a free medical clinic. According to The American Diabetes Association, an HbA1c level (obtained from a reference laboratory) 6.5% indicates a diagnosis of DM.19. Long-acting insulin preparations are used by patients with type 1 and insulin-deficient type 2 DM to provide a low level of background insulin to suppress hepatic gluconeogenesis and prevent hyperglycemia due to excess endogenous glucose production. N Engl J Med. Only 7 studies described strategies for addressing community resources and policies. Nurses worked with patients to complete a computer program to calculate 10-year risks for heart, vascular, renal, and eye disease on the basis of individual patient factors. The studies focused primarily on people aged 50 to 70 years. Diabetes Educ 2007;33(Suppl 6):132S8S. Nurses interacted most with the patients, using evidence-based algorithms from the Institute for Clinical System Integration to provide patient care and manage medications. Obstetrical Emergency in details this plan of clinical teaching. Goals of therapy in an insulin-treated patient are exclusion of a metabolic emergency; detection, treatment or prevention of marked hyperglycemia or hypoglycemia; and possibly detection of patients with poor control to encourage suitable follow up after discharge. Msc. 2010; 87: 366-371. Classification, Pathophysiology and management of Brain Stroke for Pharm.D (P Stroke I Incidence, Types, Causes, Risk Factors & Management - Dr Rohit Bhaskar, Neurology 9th vascular diseases of the nervous system, Brain stroke by Roel Tolentino Makati Philippines, Approach to a patient with stroke - Pathophysiology of stroke, Mrs. Duru Onyinye Ann Ph.D Power Point i.pptx, No public clipboards found for this slide. Med Care Res Rev 2007;64(5 Suppl):101S56S. Conclusion Acute hyperglycemia (above 400 mg/dL) is a common problem in the urgent care setting. Interactive electronic medical record was shared by patient and provider. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. WebDIY Seo Software From Locustware Is Exactly What You Need! An electronic library of messages was developed according to best available research on the use of aspirin, angiotensin-converting-enzyme inhibitors, and angiotensin receptor blockers and management methods for glycemic control, diet and exercise, dyslipidemia, hypertension, chronic heart failure, and nicotine dependence. This study identified English-language peer-reviewed research articles describing CCM-based interventions for managing type 1 and type 2 diabetes in US primary care settings (ie, hospital-network outpatient clinics, private practices, and community health centers). Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. Risk factors for severe hypoglycemia include a history of Type 1 DM (more insulin sensitive), frequent or recent severe hypoglycemia, hypoglycemia unawareness, underlying renal and liver disease, and recent alcohol intake or misuse. Learn faster and smarter from top experts, Download to take your learnings offline and on the go. We, therefore, propose involving patients in the decision whether to provide insulin and/or IV hydration. Nurses also entered patient information into the registry, and single-sheet patient reports could be generated from the registry to show self-care goals, patients trends (eg, blood pressure, HbA1c, lipids, eye examination, aspirin use, foot examination), and alerts for issues to address during the patients visit (eg, missed examination, abnormal laboratory results). Stellefson M, Chaney B, Chaney D. The digital divide in health education: myth or reality? Planned Visit Worksheet was used to ensure evidence-based diabetes care aspects were addressed during visits. Diabetes Care. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. In several studies, organizational leaders in health care systems initiated system-level reorganizations that facilitated more comprehensive and coordinated diabetes care. At the same time, development of safe, essential, life-saving surgical and anaesthesia care in Clipping is a handy way to collect important slides you want to go back to later. WebDiabetic Foot Ulcer Research Paper, Narrative Writing Worksheets Grade 3, Dissertations On Economic Development, Course Based Masters Vs Thesis Based Masters, John Cage 4'33 Essay, Coca Cola Vending Machine Case Study, Thesis Proposal For Film We collected articles from the Cochrane database of systematic reviews by using 2 distinct searches for chronic care model and diabet*, which were combined by using the word and. We also collected articles via EBSCOhost from the CINAHL database and the Health Source: Nursing/Academic Edition database by using the Boolean phrase search function for chronic care model (and) diabet*. These databases are all repositories for original health science research studies. BMJ. Metformin is considered the first-line agent for type 2 DM per American Diabetes Association and other guidelines.23 This agent has effective glucose-lowering properties, and intrinsically low risk of hypoglycemia, is available generically and cost effectively and has an excellent overall safety profile. Looks like youve clipped this slide to already. Hall AK, Stellefson M, Bernhardt JM. Xfire video game news covers all the biggest daily gaming headlines. By accepting, you agree to the updated privacy policy. Silverman RA, Thakker U, Ellman T, et al. Definition Nephrotic syndrome is a clinical complex characterized by a number of renal and extrarenal features, most prominent of which are Proteinuria (in practice > 3.0 to 3.5gm/24hrs), Hypoalbuminemia, Edema, Hypertension Hyperlipidemia, Lipiduria and Detection of Undiagnosed Diabetes and Prediabetes States in High-Risk Emergency Depertment Patients. Khan MA, Evans AT, Shah S. Caring for uninsured patients with diabetes: designing and evaluating a novel chronic care model for diabetes care. Engaging the governing boards of health care systems resulted in support for institutionalizing the CCM approach (18,22), which was associated with HbA1c reductions of at least 1% during 12 months (18,22) and improved foot care (22). There patients should understand that they need to promptly follow up with their DM care providers to obtain an ongoing supply of medications under supervision and the decision to prescribe can be individualized. Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, et al. Lifestyle school session included a model grocery store so participants could practice reading food labels, learn and apply skills to choose more healthful options during grocery shopping and when considering fast food options. County-run clinics in the Community Health Network of San Francisco. 1997; 314(7093): 1512-1515. 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