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Andrea Diedrich, RN, MS, director of continuity of care at Kishwaukee Community Hospital in DeKalb, IL, led a team of colleagues who initiated a small pilot project last year to get a feel for how case managers might improve the care of their area’s diabetic population. The 173-bed, nonprofit facility 75 miles west of Chicago has a small informal case management program at this time.
"The aim of the project was of course to improve care for those patients, but we mostly wanted to see the effect of a case manager on outcomes in the hope of increasing our case management activities within the hospital," says Diedrich.
Her team coordinated the diabetes registries of three participating physicians and gathered a group of about 20 diabetic patients whose HbA1cs were 9% or greater, then assigned an RN case manager with an expertise in diabetes.
The pilot ran from February to September 1999. "She called the patients on a weekly basis to discuss their self-management," says Diedrich. "She offered encouragement and chatted with them about things they could be doing for themselves that they may need help on."
After several months into the project, average HbA1cs came down. (See two graphs showing improvements, p. 9.) "We felt positive about our small accomplishment," she says, "and now we’re expanding upon the program. We’ll soon be working with people in our registries who have HbA1cs of 8%."
Diedrich says the pilot project encountered barriers, such as getting physician buy-in. "Also, it’s not always easy to justify the cost of a case manager — there’s a time investment, and positive outcomes are hard to measure on the short term."
Important to keep patients motivated
Keeping patients motivated was another challenge. "These patients tend to fall off the wagon,’" says Diedrich. "But for the most part, patients continued to participate in our project because they were happy to have the support and encouragement. They were happy to have someone to answer questions for them."
In the beginning, the team offered an eight-week educational session to get patients interested. "We invited every patient on the three registries," says Diedrich. "Our patient base originated with the patients who took the class, as long as they had HbA1c levels equal to or greater than 9%." Others became part of the pilot, too, if their physicians recommended them.
What were the keys to the project’s success? "For one thing, the physicians’ support with their registries," she says. "Also, the case manager we hired had credibility and respect. We set up goals for her phone calls so she knew how to direct the conversations. Also, there was good documentation so monthly follow-up flowed smoothly."
The Institute for Healthcare Improvement in Boston invited the Kishwaukee team to present their outcomes at its Oct. 28-29, 1999, National Congress in Dallas, "Improving Care for People with Chronic Conditions."
[Contact Andrea Diedrich at (815) 756-1521, ext. 8977.]