The Benefits of Assigning Case Managers to Individuals with Diabetes

Running head: THE BENEFITS OF ASSIGNING CASE MANAGERS

The Benefits of Assigning Case Managers to Individuals with Diabetes

Denise White

Florida Atlantic University

Teresa Barret, MSN, ARNP

NUR3160

April 15, 2009

There are many illnesses and diseases causing people to have a poor quality of life. Diseases such as diabetes (type I and II), are increasing in alarming numbers due to poor management by both healthcare teams and patients. According to Wikipedia (2009), the role of case manager was implemented to help coordinate a patient's care to both improve continuity and quality of care. Assigning case managers to individuals with diabetes significantly reduce emergency room visits, blood sugar levels, and secondary complications from diabetes.

Case management nursing evolved in the mid-1980s as a way of managing health care costs and patient length of stay. Case management is multifaceted and is best defined as a procedure to plan, seek, and monitor services for different social agencies and staff on behalf of a patient (Wikipedia, 2009). The following summarizes Chitty and Black's view on the functions of case manager:

A case manager is an individual who assess, plans, facilitate, and is an advocate for the patient. This involves gathering information from patient and family members about condition, planning to enhance outcomes and reduce payer's liability, facilitating communication among all parties involved, and advocating for patient's individualized needs. (Chitty & Black, 2007, pp. 368)

An important tool that makes case management successful in helping patients achieve the highest quality of living is the use of evidence-based practice. According to Chitty & Black, (as cited in Cope, 2003, p.97), evidence-based practice (EBP) means using the best available research findings "to make clinical decisions that are most effective and beneficial for patients".

In a Baltimore emergency room (ER), a study was conducted to assess what effect, if any, would assigning case managers to diabetic patients have on reducing the number of visits to the ER. During the study, the case manager worked with 100 randomly selected patients over an eighteen-month time span. Half of the patients received minimal care in which they were reminded every six months about preventative screenings and the other half received individualized care that included a yearly clinic visit. According to Brunk (2005), the findings at the end of the study confirmed that case management had a significant role in reducing ER visits by thirty percent.

Research also suggests that patients with case managers also had a reduction in blood sugar levels (Brunk, 2005). This was achieved by consistent monitoring. The nurse manager not only worked closely with the patient but also coordinated care with the physician, provided resources, monitored progress, and educated patient on taking prescribed medication.

Diabetic patients often have many complications because of consistently elevated blood sugar levels. There are many but the most common is blindness and amputations. In a recent study, case managers were assigned to 35 patients of a California diabetic clinic who had high risks favoring a future amputation because of years of poorly managed diabetes. The study showed a decline in amputation, which was due to the services provided by the case manager (Coffman, 2001).

The use of evidence-based practice in case management was not the only tool used in helping patients achieve their best health. The Neuman Systems Model, published by Betty Neuman in 1989, helped to shape the current role of case manager. This model is a total person approach to nursing and refers to an individual not only as a "patient" but also as a "client" (Neumansystemsmodel.org, 2009). By using this approach, it gives the person a since of value. One aspect of focus commonly found in helping reduce ER visits, blood glucose levels, and complications associated with diabetes is The Neuman Systems Model interventions to maintain stability. It consists of primary, secondary, and tertiary prevention (Neumansystemsmodel.org, 2009).

The focus of primary prevention is educating patients before reactions occur as in the study of individuals with high risks of developing complications from diabetes. Secondary prevention deals with intervening after a reaction has occurred. The studies referenced in previous passages are an example of this type of intervention, in which a case manager was assigned to individuals having problems with poorly managed diabetes. Lastly, tertiary prevention is taking the necessary action required to maintain stability. Case manager fulfilled this by providing resources, communicating with patient's physician, and monitoring progress. The objective of using all levels of prevention of the Neuman Systems Model is