Tailor-Made Solutions: Healthcare Professionals Embrace Case Management for Diabetes - Essay Sample

Introduction

Diabetes has grown to be one of the most prevalent chronic diseases in the United States. The rate of contraction is high among minority groups such as the black community. As a result, healthcare professionals have had to rely on a range of other techniques to manage the disease since its cure is yet to be found. Healthcare professionals decided to come up with case management as a way to provide tailor-made solutions to their patients. Case management is the use of available resources and communication to meet an individual and his or her family's health needs by providing safe and quality care through cost effective solutions. ("What Is A Case Manager"). The process usually involves advocacy for options and services, assessment, care coordination, planning, facilitation, and evaluation. Case management operates under the principle that everyone, including support systems, healthcare delivery systems, and reimbursement sources benefits when an individual achieves the maximum level of wellness, and functional capabilities. As a result, our case managers have the responsibility of identifying appropriate facilities and providers throughout the treatment process, while ensuring that the use of the available resources is timely and cost effective to generate value for the reimbursement source and the patient ("What is a Case Manager"). Therefore, the case management implementation plan will begin by establishing a specific set of goals, gain the support of the stakeholders and carry out an examination of the expected outcomes. As a result, our recommended plan for the use of case managers for patients with diabetes mellitus in our organization features the use of technology and educative materials to achieve the set goals using the support of various stakeholders.

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Implementation Plan

The case management implementation plan will revolve around three main components. The first one is the goal setting where the team sets some measurable goals that would be examined at the end of the exercise. Then there is the education implementation which seeks to provide knowledge to clients in an understandable way. The last part of the plan is electronically collect and store glucose readings of the patients for the case manager to evaluate and use to reach out to the other stakeholders.

Setting the Goals

Goals are an essential part of any case management exercise. Goals enable both the case manager and the patient to evaluate their progress and determine the effectiveness of the activity. According to Kisthardt, Rapp, & Gowdy (1992), four factors can negatively influence the goal-setting process. There is the behavioral factors, the cognitive factors, the affective and the environmental factors. A case manager seeking to set goals will need to take care of those four elements before he or she could proceed to establish long or short term goals for the project. It is because of those four elements that the project decided to seek the help of primary care physicians, utilization review personnel, chief financial officer and psychiatrists to help with the patients' mental stability.

The main requirement in the goal setting stage is to ensure that the goals are measurable. Measurable goals are based on statistical outcomes as well as time. The failure or success of the project is determined by whether the team reached the goals they had set earlier. The goals that we set to for the case management project is to get a 10 percent decrease in incidences of hyperglycemia requiring hospitalization within the next 12 months. Hyperglycemia is a primary defining feature in diabetes mellitus, and it occurs when the blood glucose level is too high because the body is not consuming the glucose or producing sufficient insulin (Fischl & Gregg, 2018).

Another goal of the project is to work towards getting the blood pressure of the adult patients to be lower than 120/80mmHg and higher than 90/60 mmHg. A blood pressure level of more than 120 over 80 poses a high risk of stroke and heart problems. On the other hand, blood pressure lower than 90 over 60 causes the risk of dizziness or lightheadedness and fainting. In severe cases, the patient could go into shock. According to the American Diabetes Association (2016), part of the strategies for improving diabetic patients cares is to reduce cardiovascular risk by addressing blood pressure. Therefore, the regulation of blood sugar should be an essential part of any case manager's goal.

Education Implementation

Part of the plan is to make the patients self-sufficient by training them and equipping them with the skills necessary to take care of themselves. Procedures such as administering insulin or measuring blood sugar levels are compulsory for emergencies when the patient is alone. Education and training is a standard procedure for diabetic patients, but this project seeks to focus on providing education that is suitable for patients with both low and high proficiency. That includes patients that are not conversant with the English language. One of the core principles is to build a team around ethnic and cultural diversity. A team that is made up of members from both majority and minority groups to allow consultation, especially in regards to treatment processes that conflict with cultural practices.

Use of Technology

Technology will be an essential part of case management especially in establishing an open line of communication between the patients, their family, and the case manager. One way to integrate the use of technology would be to create phone support. Phone support can allow case managers to continue carrying out their duties without the necessity of physical presence. Phone support also allows the patient or his family to seek consultation on various issues related to their health. It could also work when the patient attempts to travel to a different country for business or pleasure.

Also, there is also the use of electronic health records or otherwise known as the electronic medical record system (EMR). EMR is a system of collecting patient and population information electronically and storing them in a digital format (Gunter & Terry, 2005). The case managers will put the electronic health records of their patients into their electronic health documentation. The computerized method allows health practitioners, specifically case managers, to share files across different healthcare settings. That would allow the teams involved in the case management to simultaneously work on improving the patient's welfare and providing an optimum amount of care for the patient.

Approaches to Gain Buy-In from Key Stakeholders

One of the main tasks of the project will be to gain buy-in from key stakeholders. The selected approach is to get stakeholders support is by showing them the benefits they stand to reap from the plan. While choosing the stakeholders to engage, I tried to keep the number at a minimum to ensure the required approach remains simple. It is easier to convince a small group of people to support the case management project as compared to a large group of people. A large number of stakeholders will translate to a large team. It will also increase the project complexity since all stakeholders will have to buy-in to the idea. Having a large group of stakeholders increases the number of variables in the project. There could be a domino effect if one stakeholder fails to buy-into the idea or pulls out in the middle of the project. The stakeholders that I am targeting for this project includes the hospital's board of trustees, the chief executive officer, the chief financial officer, reimbursement sources such as an insurance agency, the dieticians, residents, primary care physicians, Information Technology (IT) specialists, and utilization review personnel.

The board of trustees is the most extensive set of stakeholders because of their influence on the organization. They also get to be the ones to determine the amount of resources that should be allocated to the project in the organization. Unlike the other stakeholders, the approval of the board of trustees is necessary for the project to proceed. The best approach to convince the board of trustees is to inform them how the project will benefit the organization. A case management plan is part of patient-centered care that is recommended by the American Diabetic Association for the care of patients who have diabetes (America Diabetic Association, 2016). The organization is set to directly benefit from the project which is likely to increase patient satisfaction and translate to an increased amount of revenue for the organization. As for the CFO, his input is vital for the financial management of the project. Part of case management objectives is to ensure cost effective solutions to the patients. The CFO will provide financial advice for the affordable care options available. The CFO would work along with the insurance providers to offer affordable care. The CEO and CFO could be convinced to come on board through the hospital's administration. As for the insurance, the best approach would be to show them the benefits they could derive from participating in the plan such as an increased number of customers. As for the other health practitioners such as the dieticians and physicians, I will have to coordinate with the organization's administration to free them up with some duties to allow them to take part in the project.

Key Outcomes

Some of the key outcomes of the case management plan include reduced rates of readmission among diabetic patients. The reduced cases of hyperglycemia would positively impact the health status of diabetic patients. Also, the regulation of blood sugar will also work to reduce cardiovascular complications among diabetic patients. However, one of the most critical outcomes would be improved quality of care due to educational outreach conducted by the team. Most of the patients suffering from diabetes mellitus will be able to administer personal care as well as conform to other requirements in dietary and exercise. The case management plan is sensitive to cultural needs and would, therefore, encourage more clients from different cultural backgrounds to visit the institution and take part in case management.

Conclusion

Case management, just like evidence-based practice is one of the most recent trends in the field of healthcare. The diabetic population is on the rise in America, and there is a need to come up with a comprehensive plan to take care of the community. Case management is the best way to provide treatment from those infected with diabetes. The case management plan that I developed aims at providing tailor-made solutions that focus on cultural sensitivity and cost effective solutions. The goals of the project are to reduce the incidences of hyperglycemia among diabetic patients. The second goal is to get the blood pressure of diabetic patients to the recommended levels. The plan seeks to achieve these goals by using education and incorporating technology. The preferred approach to gain critical stakeholders is to inform them about the possible benefits that the organization and the diabetic community could reap from the plan. All these factors seek to improve overall patient satisfaction and help the organization reach its objective of providing patient-centered care.

References

American Diabetes Association. (2016, January 01). 1. Strategies for Improving Care. Retrieved May 3, 2019, from http://care.diabetesjournals.org/content/39/Supplement_1/S6

Fischl, A. H. (2018, July 9). Hyperglycemia: When Your Blood Glucose Level Goes Too High (B. Gregg, Ed.). Retrieved May 3, 2019, from https://www.endocrineweb.com/conditions/hyperglycemia/hyperglycemia-when-your-blood-glucose-level-goes-too-high

Gunter, T. D.,...