Diabetes: Controlling the Out-of-Control
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This article appears in the January/February 2014 issue of HealthLeaders magazine.
In 1999, Saint Mary's Hospital in Grand Rapids, Mich., opened a diabetes center. Little did hospital officials know then, but they were ahead of their time and today are confronting a disease that affects about 8.3% of the U.S. population.
Other healthcare leaders are responding, too, devoting resources to help overcome a disease that some view as rampant or out of control. To try to stem the increasing incidence, education programs are booming. Electronic medical records are in demand. Physician groups and hospitals are using apps to engage in patients in the moment. Physicians and pharmacists are teaming up to ensure patients know about their medications.
In 2011, Saint Mary's Health Care was renamed Mercy Health Saint Mary's, as part of Saint Mary's in Grand Rapids and Mercy Health Partners in Muskegon. The regional system includes five hospital campuses with 800 total beds. It is part of Trinity Health, the national Catholic hospital system based in Livonia, Mich.
Mercy Health Saint Mary's original diabetes center merged with Thyroid Specialists of West Michigan to become what it is today, Mercy Health Physician Partners Diabetes & Endocrine Center in Grand Rapids. The organization's diabetic care framework is much more sophisticated today, as a multidisciplinary team evaluates patients and coordinates care for a growing patient population.
"Diabetes is a dynamic disease that is always changing, and we look to be on the cutting edge," says Mary Harnish, RN, clinical nurse leader who oversees the inpatient diabetes program at Mercy Health Saint Mary's, which in 2011 received inpatient diabetes certification from The Joint Commission.
"We expect to see increases across the nation, not only because of an increase of obesity but also because we are doing a better job of catching diabetes. Primary care physicians are doing a good job of screening," Harnish says. "People are coming to the hospital who may not have a primary care doctor, and those who are seeking care are so sick they are coming to the emergency room. That's always a challenge and shows how important it is to have early detection by primary care doctors."
Diabetes requires continuing medical care, plus ongoing patient self-management and education to prevent acute and long-term complications. Some patients "have a passion about taking care of themselves, while other are less attentive to the self-care of their disease," says Harnish.
For hospitals, focusing on diabetes is a potentially significant area for its other service lines, such as cardiovascular or oncology programs. Hospitals are launching specific diabetes-focused efforts and teaming up with other facilities and insurers, initiating education programs, tapping into technology, and intensifying follow-up care.
The diabetes patients are at higher risk than other patients for complications, falls, and longer lengths of stay, which can have economic implications. Starting in fiscal year 2015, hospitals that have high healthcare-acquired complication rates will see their Medicare payments cut 1%. Hospitals targeted for such cuts would be in the top quarter for the rate of hospital-acquired conditions, such as infections or falls, as compared to the national average, according to the Association of American Medical Colleges.
Deebeanne M. Tavani, DO, chief of the division of endocrinology at Main Line Health System, which serves Philadelphia and several suburbs, keeps tabs of the numbers. "Another 12 million people actually walk the streets of America meeting the criteria of diabetes and don't even know it," says Tavani. About one in 10 have diabetes now, she says. Main Line Health includes 331-bed Lankenau Medical Center, 319-bed Bryn Mawr Hospital, 231-bed Paoli Hospital, and 204-bed Riddle Hospital.
When diabetes strikes during childhood, it is often assumed to be type 1 or juvenile-onset diabetes, but children are now being diagnosed with type 2 diabetes, formerly known as adult-onset.
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