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The MedStar Diabetes Institute (MDI), in partnership with key MedStar Health system diabetes stakeholders, seeks to implement an evidence-based innovative integrated care pathway for MedStar patients with uncontrolled diabetes which will demonstrate improvement in diabetes care outcomes.
- The program is designed to bring diabetes specialty services to Primary Care practices to support PCPs and their patients in improving diabetes-related outcomes.
- High-risk patients from MedStar Primary Care practices who have uncontrolled type 2 diabetes and meet the target population inclusion and exclusion criteria will be invited to participate in an intensive and concise medication management and education intervention of ~4-8 weeks duration.
- The intervention will consist of three key components: (1) intensive, algorithm-based medication management (Appendix A), based on continuous review and management of blood sugars; (2) survival skills diabetes self-management education; (3) enhanced patient-provider communication, all provided by Endocrinologist supervised allied health professionals (in this instance CDEs).
- Survival skills DSME will focus on nutrition and meal plan basics, blood glucose targets, taking medications as prescribed, hyper- and hypoglycemia recognition and treatment, and when to seek medical help.
- The intervention will start with one to two face-to-face meetings with the CDE, to be followed by virtual meetings though a variety of media based on patient preference and health literacy.
- Various technology tools will be used to facilitate patient engagement and attainment of glycemic targets, including smart meters, virtual meeting platforms, web-based education content and surveys via tablets, etc.
- Concurrent matched charts of patients receiving standard care at the three MedStar locations will serve as a basis of comparison in assessing the impact of MDI on clinical and education outcomes and process of care.
- Based on patient progress towards improved glycemic control, the patient will 'graduate' from the program and the CDE will refer the patient back to their PCP in 8-12 weeks with a full report of medication changes, blood glucose readings and further diabetes management recommendations eg referrals; further DSME, etc.
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Active, not recruiting
Medstar Health Research Institute
Published on BioPortfolio: 2016-10-06T00:38:21-0400
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Excessive thirst manifested by excessive fluid intake. It is characteristic of many diseases such as DIABETES MELLITUS; DIABETES INSIPIDUS; and NEPHROGENIC DIABETES INSIPIDUS. The condition may be psychogenic in origin.
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