Development and Implementation of a Collaborative Team Care Model for Effective Insulin Use in an Academic Medical Center Primary Care Network

Abstract

Improving glycemic control across a primary care diabetes population is challenging. This article describes the development, implementation, and outcomes of the Diabetes Care Collaborative Model (DCCM), a collaborative team care process focused on promoting effective insulin use targeting patients with hyperglycemia in a patient-centered medical home model. After a pilot, the DCCM was implemented in 18 primary care practices affiliated with an academic medical center. Its implementation was associated with improvements in glycemic control and increase in insulin prescription longitudinally and across the entire population, with a >1% reduction in the proportion of glycated hemoglobin >9% at 2 years after the implementation compared with the 2 years prior ( P < .001). Facilitating factors included diverse stakeholder engagement, institutional alignment of priorities, awarding various types of credits for participation and implementation to providers, and a strong theoretical foundation using the principles of the collaborative care model.

Multidisciplinary coordinated care for Type 2 diabetes: A qualitative analysis of patient perspectives

“…[7] In brief, the program had the following core elements, shared by all practices: 1) A physician leader for support of the project, 2) A nurse (or nurse practitioner) diabetes champion who managed a population health diabetes registry, served as a single point of contact for patients, and coordinated diabetes management plans with the patient’s primary care physician and specialists, and 3) An assigned dietitian who accommodated and expedited referrals for nutrition counseling. [7] The diabetes champions used management protocols that specifically incorporated motivational interviewing techniques, scheduled ‘check-ins’ that were not tied to a clinic visit, and evidence-based protocols for insulin initiation and titration. [7] Implementation varied across clinics in two main ways—whether or not the dietitian was located on site, and whether the practice added other members of the practice to their core care team, such as medical assistants or front desk staff.…”

“…Our academic medical center implemented a diabetes team care model within 20 primary care practices that were part of our practice-based research network between 2012 and 2014. [7] The model shifted the focus of diabetes care from a model that centered on the doctor-patient relationship with referrals to certified diabetes educators and dietitians as needed, to one that emphasized more protocolized, multidisciplinary care involving practice-based nurses and dietitians, embedded locally in clinics. [7] An evaluation of the model found significant improvement in glycemic control for patients with hemoglobin A1c > 9.0%.…”

“…[7] The model shifted the focus of diabetes care from a model that centered on the doctor-patient relationship with referrals to certified diabetes educators and dietitians as needed, to one that emphasized more protocolized, multidisciplinary care involving practice-based nurses and dietitians, embedded locally in clinics. [7] An evaluation of the model found significant improvement in glycemic control for patients with hemoglobin A1c > 9.0%. [7] In this project, we sought to understand the patient experience of diabetes care and patient perspective on team care, as well as to determine preferences for the provision of ideal diabetes care, both to shape the model and to identify any potential pitfalls of this approach.…”

“…[7] An evaluation of the model found significant improvement in glycemic control for patients with hemoglobin A1c > 9.0%. [7] In this project, we sought to understand the patient experience of diabetes care and patient perspective on team care, as well as to determine preferences for the provision of ideal diabetes care, both to shape the model and to identify any potential pitfalls of this approach. Specifically, our goal was to obtain patient perspectives that could drive implementation of patient-centered diabetes care in the primary care setting.…”

Dysglycemia-Based Chronic Disease: An American Association of Clinical Endocrinologists Position Statement

“…In a study by Eisenstat et al (155) primarily addressing insulin use, patients with prediabetes and T2D were followed by a coordinated team in a network of primary care physicians, using evidencebased recommendations addressing medical, behavioral, and nutrition/lifestyle components. Certain factors were identified that facilitated care: diverse stakeholder engagement and buy-in with the theoretical basis of the model, institutional alignment of priorities, and credits for participation and implementation (155). The close integration of pharmacists can also improve adherence factors in the care model (156).…”