a telehealth integrated chronic care management model (ccm
Post on 23-Feb-2022
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Background
Literature Review
Ida Jean Orlando’s 1961 Nursing Process Theory
Implications, Recommendations , & Relevance to Nursing
Measurable/Targeted outcomes
Projection Description
Conclusion
A Telehealth Integrated Chronic Care Management Model (CCM) for Type II Diabetes
Ryan E. Baumgartner, B.S.N., R.N.Xavier University College of Nursing
Purpose
Planned Evaluation
DiscussionChange Theory
This theory offers nurses guidance for framing care delivery
models when circumstances require technology in nursing
practice.
The development of new nursing practices to include modern
technologies is essential for overcoming barriers to patient care.
In Orlando's theory, the nurse's role is to seek out and meet the
patient's immediate needs. As the pandemic has restricted access to
care, patients experience distress in not having their needs met.
Using these principles, an approach to remote diabetic care allows
the nurse to appropriately and promptly respond to the patients'
needs has been framed (Alligood, 2018).
Telemedicine has become a critical strategy to improve access
to diabetes care during the CoVID-19 Pandemic.
The CoVID-19 Pandemic has socially distanced the public and
changed operations at the Cincinnati Health Department
(CHD).
Adjustments in the delivery of essential patient care had to be
made and routine office appointments for CCM were
suddenly canceled.
CHD’s leadership searched for innovative models for
providing remote diabetic care that is cost-effective, efficient,
and safe.
This project aims to develop a chronic care management
(CCM) model that integrates telehealth services for the
delivery of nursing care to the type 2 diabetic (DM2) patient.
The overarching goal is to have this model adopted and
implemented into practice at the Cincinnati Health
Department (CHD).
A well-developed and effective diabetes care management
model's objective is to control blood glucose.
This objective can be accomplished in two ways using
telehealth as the delivery platform.
Healthy lifestyle modification, including dietary changes,
regular physical exercise, weight reduction as specified by
the nurse
Provide medication management.
This literature review identified and evaluated high-quality,
evidence-based practices (EBP) in scholarly articles, reviews,
studies, and meta-analyses, providing evidence that the
combination of telehealth technologies with diabetic CCM
could be a practical approach to managing glycemic control in
the DM2 patient remotely.
The three databases used most frequently in this literature
search were PubMed, MEDLINE, and CINAHL, using the search
words telehealth, chronic disease, patient education, and related
concepts.
Sufficient evidence supporting these tenets was uncovered,
suggesting developing a telehealth-integrated CCM model for
the DM2 patient will be effective, cost-efficient, and safe while
improving patient outcomes and clinical practices.
This review examined citations from government websites that
provided research strategies for finding clinical studies, EBP, and
systematic reviews.
The Delivery System Design element of the Tele-CCM Model
assures efficient, effective care and self-management support
(Gee et al., 2015).
This element comes with five change concepts. These concepts
are foundational to the structure of the Tele-CCM Model. They
include the following: a) define roles and distribute tasks
among team members, b) use planned interactions to support
evidence-based care, c) provide clinical case management
services for complex patients, d) ensure regular follow-up by
the care team, and e) give care that patients understand, and
that agrees with their cultural background.
These concepts provided a framework for structuring the
diabetic care management component of this new Model.
Like the Tele-CCM Model developed for this project, previous
models aimed to improve clinical outcomes, patient experience,
nurse/provider satisfaction, and reduce costs (Ali et al., 2013).
When the Tele-CCM Model is adopted and implemented, CHD
administration can expect improved patient outcomes.
These improvements can be used to monitor plan objectives using
the HRSA quality measures to benchmark project progress.
HRSA endorsed the IOM to examine the potential of telehealth
care delivery services over two decades ago. One of these metrics
included the Hgba1c.
Point-of-Care HgbA1c’s will be collected on-site every 3 months.
When reductions in this value are observed in patients provided
with Tele-CCM nursing services, it will indicate the successful
implementation of the Model.
Harrison’s Model illustrates the
relationship between culture,
behavior, technology, and
structure related to external
forces. The organization must use
what resources (input) they have
available to them and incorporate
them (telehealth) into their
processes (diabetes care) to
provide essential patient services
(output). From Touson et al.
(2021). Harrison’s Model applied to
Orlando’s Nursing Process
Theory (below).
Utilization: Tracking of nurse telehealth encounters will be
reported once a week. The site champion will also be the CCM-
C. Initially, the target goal will be ten completed Tele-CCM at
each health center (one nurse) per week. The target goal will
increase incrementally as the nurse uses the new care model.
Clinical Outcomes: Baseline values should be noted before the
initial Tele-CCM visit, and these values should be reevaluated at
three-month intervals. When reductions (improvements) in
these values are observed, program effectiveness can be assumed
Profitability: Benchmarking clinical improvements and outcomes
with metrics meet HRSA quality standards. When these
standards are met, the organization is awarded federal funding.
User Satisfaction: Feedback from point-of-care providers and
patients is critical (McGlynn et al., 2012). Semiannual surveys
will be distributed to patients receiving Tele-CCM and the nurses
who provide it. These surveys will be anonymous.
As other industries seamlessly moved to virtual interactions,
healthcare organizations, like the CHD, are continually
challenged with their obligations to provide patient care in a
virtual capacity.
The organization’s leadership continues to search for
innovative models for delivering remote diabetic care that is
cost-effective, efficient, and safe to the population they serve.
Future adoption of the Tele-CCM Model by CHD leadership,
coupled with stakeholder participation, will allow the CHD to
deliver a much-needed service to those socially distanced
populations further removed from access to care by the
pandemic restrictions.
In a recent study (ADA, 2021) 2,500 individuals with DM2 found
that 9% of respondents said they could not afford medical care
during the pandemic.
One in five people said they had foregone getting an insulin pump or
continuous glucose monitor (CGM), attributing financial strain.
15% of people with diabetes who rely on management technologies
like pumps or CGMs have delayed refilling diabetic testing supplies
and needles during the pandemic;
70% of these respondents, this was also due to financial strain.
12% of people with diabetes have experienced a disruption in
insurance coverage since the start of the pandemic; of those who lost
coverage due to the pandemic, half could not regain coverage.
In a related survey (Solberg et al. 2021), researchers found that
despite these setbacks faced by the DM2 population during the
pandemic, many have appeared to benefit from increased access and
use of telehealth services.
73% percent of people with DM2 have used telehealth services
during the pandemic, compared to 11% before CoVID-19. Of those
who have utilized telehealth, 40% report that it has made it easier to
manage their diabetes, compared with 37% who reported no change.
36% say they plan to continue seeking health care remotely after the
pandemic (Solberg et al., 2021).
Nurse Tele-CCM visits offer a broader reach to
the larger communities. Giving nurses the ability
to manage diabetic care via telehealth can
maintain the patient-provider relationship.
It also is an avenue by which nurses can
reestablish relationships between the CHD and
members of the community lost to care in the
wake of the pandemic (Fursse et al., 2008).
The Tele-CCM Model can guide tentative
payment structures that manage the current
national state of emergency and help prepare
the CHD’s financial officers to negotiate for
future payor reimbursement plans (Rittenhouse
& Peikes, 2020).
Tele-CCM Services Model for Diabetes Type II
References
Ali, M. K., Bullard, K. M., Saaddine, J. B., Cowie, C. C., Imperatore, G., & Gregg, E. W. (2013). Achievement of goals in US
diabetes care, 1999-2010. New England Journal of Medicine, 368(17), 1613–1624. https://doi-
org.nocdbproxy.xavier.edu/10.1056/NEJMsa1213829
Alligood, M.R. (2018). Nursing theorists and their work (9th ed.). Elsevier.
American Diabetes Association. (2021). Diabetes and Coronavirus: How CoVID-19 impacts people with diabetes.
https://www.diabetes.org/coronavirus-covid-19/how-coronavirus-impacts-people-with-diabetes
Fursse, J., Clarke, M., Jones, R., Khemka, S., & Findlay, G. (2008). Early experience in using telemonitoring for the management
of chronic disease in primary care. Journal of Telemedicine and Telecare, 14(3), 122–124. https://doi-
org.nocdbproxy.xavier.edu/10.1258/jtt.2008.003005
Gee, P. M., Greenwood, D. A., Paterniti, D. A., Ward, D., & Miller, L. M. S. (2015). The eHealth enhanced chronic care model: A
theory derivation approach. Journal of medical Internet research, 17(4), e86.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398883/
McGlynn, K., Griffin, M. Q., Donahue, M., & Fitzpatrick, J. J. (2012). Registered nurse job satisfaction and satisfaction with the
professional practice model. Journal of Nursing Management, 20(2), 260-265. doi:10.1111/j.1365-2834.2011.01351.x
Rittenhouse, D., & Peikes, D. (2020, July 13). Effectively implementing telehealth in primary care. Mathematica.
https://www.mathematica.org/commentary/effectively-implementing-telehealth-in-primary-
care#:~:text=Telephone%20visits%20are%20the%20simplest,familiarity%20with%2C%20the%20necessary%20technology
Solberg, L., Peterson, K., Fu, H., Eder, M., Jacobson, R., Carlin, C. (2021). Strategies and factors associated with top performance
in primary care for diabetes: Insights from a mixed methods study. Annals of Family Medicine., 19(2), 110-116.
doi:10.1370/afm.2646
Touson, J. C., Azad, N., Depue, C., Crimmins, T., & Long, R. (2021). An application of Harrison’s system theory model to spark a
rapid telehealth expansion in the time of CoVID‐19. Learning Health Systems, 5(1), 1–5. https://doi-
org.nocdbproxy.xavier.edu/10.1002/lrh2.10239
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