Hospitals in pursuit of excellence

Identify then Empower Diabetes Patients

Engaging and training diabetes patients is helping to change and save lives. Here's how: Rowan Regional Medical Center, Salisbury, NC, has developed a disease management program aimed at reducing readmissions. Work started with the Igloo initiative at RRMC and has expanded to a project funded by a Beacon Community grant serving Rowan, Cabarrus and Stanly counties. Yogesh K. Patel, M.D., oversees the transitional care program at RRMC, and diabetes is one of the targeted conditions. "We're figuring out ways to meet the needs of patients and community by filling in gaps," says Patel. The diabetes program has shown solid preliminary results, starting with identifying more patients who need care. The goal is to have every admitted patient obtain an A1C test to screen for diabetes. So far each month, RRMC is identifying 15 to 35 patients suspected to have newly diagnosed diabetes. Patients with A1C levels more than 6.5 percent are connected with diabetes navigator Rebecca Slone, R.N. At the hospital, Slone helps patients get initial training, a blood glucose meter and medications. To coordinate care, primary care physicians and patients receive test results and recommendations. Slone follows up by phone and helps train patients, focusing on those newly diagnosed or with A1C levels greater than 9 percent, to become their own caregiver. Slone has seen patients lower their A1C from 12 percent to 6.7 percent. These are fairly complex conditions, but most people are eager to learn how to improve diabetes control, Slone emphasizes.