Diabetes & Healthcare Administration

According to the American Diabetes Association, 29.1 million Americans, or 9.3% of the U.S. population, were affected by diabetes mellitus in 2012.1 In the same year, the total costs of diagnosed diabetics was $245 billion dollars, $176 billion of which was direct medical cost.1 Administrators need to determine how successful client education programs, home management, and complications are in health promotion. This article will address the etiology, screening standards, scope of research, and health administration implications.

Diabetes is a decrease in the secretion of insulin by the beta cells of the pancreas. Thus the increase in glucose and carbohydrate intake can cause a challenge to the pancreas to metabolize glucose. This element causes protein and fat metabolism, which causes a state of hyper – or hypoglycemia. This physiological state is accelerated due to the demand of insulin-energy cycle to break down fats, carbohydrates and glucose. Diabetes mellitus has several different categories that fall under this chronic condition, such as insulin dependent diabetes (type 1), non-insulin dependent diabetes (type 2), gestational diabetes, and mal-nutritional related diabetes.2 Diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians.1 It is also more common among obese individuals and individuals with a family history of diabetes. During personal management, diabetes requires treatment to optimize blood glucose levels to lessen the risk of complications, which could include: diabetic ketoacidosis, hyperosmolar hyperglycemic non-ketotic disease, coronary artery disease, hypertension, diabetic retinopathy, diabetic neuropathy, renal failure, and amputations. Watts, Lawrence, and Kern (2011) states that many patients remain at high risk for diabetes complications because of poor glycemic control.3 Therefore, strict glycemic controls through diet or medical treatment lowers the risks of these adverse outcomes. The medical treatments for diabetes are oral hypoglycemic medications, thiazolidinedione, insulin, insulin delivery systems, and pancreatic transplantation.

Screening for Diabetes
Healthcare professionals are recommended to screen high risk individuals for diabetes during the annual medical visit. World Health Organization defines diagnostic criteria for diabetes as fasting blood sugar, oral glucose tolerance test, random plasma glucose, and glycosylated hemoglobin levels.2 Private practices and community health centers are using the national standard as a guide to direct their clinical practice. Clinical goals for the diabetic patients are LDL<100m/dl, HgbA1C <7.5, and SBP<135 based on the national standards. Many healthcare systems are tracking their data by collecting compliance figures from their diabetic registries. These registries are allowing for data analysis, access to integrated chronic medical services, delivery of quality diabetic care and patient education.

Scope of Research
Research and statistical data has shown that chronic disease management is costing billions of dollars to manage. The medical home model is the driving force for primary care delivery. However, more and more healthcare organizations are moving to a patient-centered medical homes to treat chronic diseases such as diabetes. A recent article examines the overall efficiency that community health centers have on the delivery of quality diabetic care.4 A majority of the community health center clients are uninsured, or receiving medical assistance. The article promotes the usage of the patient-centered medical home model rather than the medical home model for organized primary care.4 The National Committee for Quality Assurance (NCQA) assessment tool is used to analyze the efficiency in delivering quality diabetic care in the traditional medical home model. The government’s Healthy People 2020 initiative aims to reduce the disparities associated with diabetes and increase the longevity of diabetic patients by decreasing or eliminating the associated complications.

According to Walton et al., “Disparities in the prevalence of type 2 diabetes and complications in underserved populations have been linked to poor quality of care including lack of access to diabetic management programs. Interventions utilizing community workers (CHWs) to assist with diabetic management have demonstrated improvements in patient outcomes.”5

Poor quality of health is causing hospitals, community clinics, and managed care organizations to initiate community-based programs. These programs are focused on diabetes education and chronic disease management, which has drastically reduced the number of new cases of diabetes-associated complications. This type of health promotion is showcased by MultiCare Health System in Tacoma Wash.6 Their program was able to achieve an 11.8% overall improvement in clinical outcomes from a 7.3% over a two year span.6

Healthcare Administration Implications
The implications of diabetes upon the management of community health programs in private practices, community health clinics, and managed care organizations is the delivery of care, revenue outcomes, and quality management. An administrator should examine the success rate of a program by reviewing the data associated with the clinical outcome.

Delivery of care is governed by regulatory policies and standard operating procedures based on federal and state initiatives. These initiatives affect an array of medical outlets that provide chronic care treatment and education. High costs are incurred from provider service fee rates, diagnostic services, patient education on disease process and self-management, nutritional consultation, and follow-up medical visits.

Cost containment is interfering with the adequate state of delivery of medical service to those with diabetes. Cost effectiveness is measured by cost-benefit analysis in regard to the validity of the chronic care program. This analysis assists in the determination of solid revenue outcome, not just through pay-for-fee services, and contractual insurance agreements between clinics, healthcare systems, and community health centers. The uninsured and the Center for Medicaid and Medicare recipients are the individuals that receive mediocre quality of diabetes care due to financial restraints.

SEE ALSO: Diabetes Education Programs

Quality management verifies the compliance in delivering safe, quality diabetes care. The patient-centered medical model is a collaborative and comprehensive effort by the inter-disciplinary healthcare team to engage provider and client. Clinical encounters between the provider and client foster quality diabetes education and client empowerment. Clinical decision-making guides between administrators, clinical staff, and senior management appeals to performance measurement, patient satisfaction, and safety.

Based on the research, diabetes has an impact on healthcare administration significantly in the realms of quality, safety, revenue acquisition, and delivery of care in various healthcare organizations. Administrators are learning and expanding on new and inventive methods in delivering superb medical services to the insured, uninsured and underinsured. The literature presented in this article has examined management of diabetes and administrative factors that affect the capacity to provide a chronic care program effectively.

Gloria Sasu is a Master in Healthcare Administration candidate and a clinical nurse for Adventist Healthcare Inc. in Takoma Park, Md.

1. American Diabetes Association. Statistics About Diabetes. http://www.diabetes.org/diabetes-basics/statistics/.
2. World Health Organization. Diabetes Fact Sheet. http://www.who.int/mediacentre/factsheets/fs312/en/.
3. Watts S, et al. Diabetes nurse case management training program: enhancing care consistent with chronic care and patient centered medical home models. Clinical Diabetes. 2011;29.
4. Rivero E. Diabetes: Tool assessing how community health centers deliver ‘medical home’ care may be flawed. UCLA Newsroom. 2012. http://newsroom.ucla.edu/releases/tool-assessing-how-well-community-228219.
5. Walton J, et al. Reducing diabetes disparities through implementation of community health workers-led diabetes self-management education programs. Family and Community Health. 2012;35(2):161.
6. Baron A, et al. Creating a Diabetes Chronic Disease Management Program that Works. Physician Executive Journal. 2011:32-39.

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