Overcoming turf battles: developing a pragmatic, collaborative model to improve glycemic control in patients with diabetes.
BACKGROUND
Collaboration between primary care physicians (PCPs) and endocrinologists should be the first step in improving care of patients with diabetes. However, the coordination of care between specialists and PCPs often does not work well. At Vanderbilt University Medical Center, a collaborative model between PCPs and endocrinology was used in an effort to improve glycemic control for patients with diabetes.


METHODS
In 1998 a project team was formed; the team members attempted to find ways to improve the care of patients with diabetes, specifically patients with poor glycemic control. The team proceeded through ten iterations of the model before reaching one accepted by all-one with clear responsibilities and referral criteria.


RESULTS
Survey results indicated a high level of satisfaction with the collaborative model among patients and PCPs. Appropriate referrals to the diabetes improvement program--a 12-week outpatient program consisting of instruction and support in diabetes self-management coupled with adjustment of insulin and oral hypoglycemic medications-increased during the team effort, and a control chart indicated a change in the process that was significant and sustained. The patients enrolled in the program experienced a reduction of mean glycated hemoglobin levels from 9.2% at entry to 7.5% after 3 months (p < 0.05).


CONCLUSIONS
An initial first step to improving care is to create an environment of trust and collaboration between the PCPs and specialists who assist in that care. After this collaboration has been established, many of the improvements identified in other studies can more easily be implemented.
Quinn
D C
DC
Center for Clinical Improvement, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Doris.Quinn@mcmail.vanderbilt.edu
Graber
A L
AL
Elasy
T A
TA
Thomas
J
J
Wolff
K
K
Brown
A
A
D000328:Adult; D000553:Ambulatory Care / Q000592:standards*; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000097:blood* / Q000517:prevention & control*; D004704:Endocrinology / Q000458:organization & administration* / Q000592:standards; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration*; D012944:Social Support; D013714:Tennessee; D017749:Total Quality Management / Q000458:organization & administration*
D006442:Glycated Hemoglobin