To address such cases, the hospital works with healthcare coaches in primary care offices "to keep people on task to make sure they are following through with diet and exercise goals and to help keep them motivated," Harnish says. They particularly monitor those with prediabetes and in follow-up care make clear to patients: "You are heading toward diabetes. You're in the prediabetes stage."
Mercy Saint Mary's team focus also has steered the hospital toward continual innovations in diabetes care, she says. Several years ago the hospital improved physician protocols for diabetes control by implementing a basal-bolus regimen for glycemic control.
The hospital found the treatment better than what it had been using, a sliding-scale regular insulin practice. Some studies have shown the basal-bolus regimen has resulted in less treatment failure. The hospital uses electronic medical records to monitor blood glucose readings directly from meters for bedside testing, Harnish says, "which was a huge improvement" in patient care.
Success key No. 2: Partnerships with pharmacists
In Ohio and elsewhere around the country, physicians and pharmacists are simultaneously seeing diabetic inpatients to improve care. Both can answer the patients' questions, and the dual effort "allows a more comprehensive understanding of diabetes by the patient and more patient-specific therapy changes," says Stuart J. Beatty, PharmD, BCPS, CDE, assistant professor of clinical pharmacy at the Ohio State University College of Pharmacy.
The coordination continues after the patient visit: A note is shared electronically with the primary care physician, which improves efficiency during the next office visit, says Michael S. Langan, MD, FACP, director of the primary care track, at OSU CarePoint East, an outpatient clinic in Columbus that is part of the 976-licensed-bed Ohio State University Wexner Medical Center. The note can lead to improved clinical care because the primary care physician can follow up on any acute issues regarding diabetes, he says.
"Additionally, the pharmacists often call the patients in between office visits to check in on diabetes treatment adjustments and/or goals. The calls are documented within the EMR and shared with the primary care team," Beatty says. "Changes made at diabetes clinics are communicated with the community pharmacy through either a telephone call or through electronic prescribing, as appropriate."
OSU CarePoint East uses a patient-centered medical home model and includes attending physicians, resident physicians, pharmacy faculty, pharmacy residents, nurse practitioners, registered nurses, medical assistants, and social workers in the same office. CarePoint is a community outreach location of Ohio State University Wexner Medical Center. Each CarePoint location provides routine and specialty care, such as diabetes, cardiology, orthopedics, radiology, and primary care. The same EMR that is used at the medical center is used at this and other outpatient facilities so that information from both inpatient and outpatient procedures is included in the documentation, says Beatty.
"If we have a patient who has been hospitalized at OSU, we can look through the hospital-stay labs, procedures, medication changes, and documentation very easily because we are in the same EMR," says Langan.
The OSU College of Pharmacy has been involved in a program known as Project IMPACT: Diabetes, which includes clinicians and about 2,000 patients in 25 communities across the country focusing on improving the health of patients who are diabetic. According to six months of data collected from the program in 2012, there was a 0.7-point reduction in A1C levels, from 9.0% to 8.3%, and a reduction in LDL cholesterol from 99.5 mg/dL to 92.2 mg/dL.
Pharmacists collaborate and refer patients to other healthcare providers to ensure that patients receive comprehensive care, says Benjamin Bluml, senior vice president for research and innovation at the American Pharmacists Association Foundation, who designed and is leading Project IMPACT: Diabetes.