Diabetes Basket of Care

Transcription

1 Diabetes Basket of Care Scope: Assessment, monitoring, and out management of adult s (ages 18 to 75 years of age) with "uncomplicated" diabetes excluding those individuals with known diabetic complications and/or other severe conditions as specifically defined below the matrix* Key: Green=Consensus to include, Blue=Consensus to exclude Components Required component (Y or N) Quantity in 1 year (if evidence supports frequency of service) Required provider type (primary care physician, specialty physician, advanced practice provider, nurse, educator, registered dietician, physical therapist, pharmacist, etc.) Delivery modalities (Evisits, phone ) Rationale (source of evidence that supports position) Primary care evaluation (history, vital signs, counseling, test coordination) Y (4) Specialty care evaluation Y (1), N (1) Complex assessment Y (1) Vascular risk assessment and prevention Y (1) PolyPharmacy assessment Y (2) Home blood pressure assessment Y (1) Eye exam Y (4) annually, as many as needed for the Primary care physician or clinician coordinated team, NP one bundled PCP, NP, pharmacist retinal photography screening or comprehensive evaluation by Opthalmologist or optometrist-yearly office visit Care; 2009 ICSI 2009; al assessment and evaluation should be included, even to assif complex, untill turns into a complex case. Must then agree on what is a complex case. Care 2009; ICSI 2009; DRS Am J Opthalmol v81 p ; ETDRS Arch Opthalmol v103 p ;

2 unless prior eye exam within 2 years was normal Foot exam Y (4) Psychological assessment (for example evaluation of severe mood swings) Y (4) Monitoring: A1c Y (4) Glucose monitoring Y (3) Lipid profile Y (3) Nephropathy assessment (microalbumin and/or creatinine) Y (3) Liver function tests Y (3) Electrolytes Y (1) Management: Primary care physician or clinician coordinated team, NP, diabetes educator, podiatrist Primary care physician or clinician coordinated team, NP, diabetes educator, RN office visit minimum of 1 in last 6 months, 2-4 X/yr, as many as bundled lab visit 2-7 X per day, as lab visit lab visit Care 2009; ICSI 2009; Mayfield et al D Care v21 p ; Anderson et al D Care v24 p ; DeGroot et al Psycho Med v63 p ; PHQ9 or PHQ2? Evaluation for frequent BG swings?; Care 2009; ICSI 2009; Knopp et al D Care v 29 p ; Singh et al JAMA v298 p ; Care 2009; ICSI 2009;

3 Where appropriate, Medication management Y (4) provider, pharmacist Insulin pump management Y (1), N(1) Diabetes educator Physical activity counseling Y (3), Included in Med Nutrition Therapy Medical nutrition therapy Y (4) Nutrition counseling Weight management Y (3), Included in Med Nutrition Therapy Y (3), Included in Med Nutrition Therapy Minimum of 1, Per Medicare reimbursement 3 visits in first year of diagnosis and 2 visits in successive years, as many as bundled Minimum of 1, Per Medicare reimbursement 3 visits in first year of diagnosis and 2 visits in successive years, as many as bundled Minimum of 1, Per Medicare reimbursement 3 visits in first year of diagnosis and 2 visits in successive years, as many as provider, nurse, diabetes educator, exercise physiologist, physical therapist provider, nurse, provider, nurse, diabetes educator provider, nurse, ) American Diabetes Assoc Standards of Care 2009; Nathan et al Clinical Diabetes : 4-16; Care 2009; ICSI 2009; Sigal D Care v27 p ; Care 2009; ICSI 2009; ADA consencus D Care v29 p ; Sheils J, et al (1999); Care 2009; ICSI 2009; ADA consencus D Care v29 p ; Care 2009; ICSI 2009; ADA consencus D Care v29 p ; Klein et al D Care v27 p ;

4 bundled Education counseling Y (4) Behavioral services N (1) Patient education on self management Y (4) Hypoglycemia awareness training Y (2) Intensive insulin and multiple daily injection training Y (2) Reflectance meter glucose management Y (1), N(1) CARE management Y (1) Minimum of 1, 10 hours of diabetes self management training as part of group or individual visits, as many as bundled Minimum of 1, 10 hours of diabetes self management training as part of group or individual visits, as many as bundled provider, nurse, certified diabetes educator provider, nurse, certified diabetes educator diabetes educator PCP, NP, diabetes educator pt pt pt Care 2009; ICSI 2009; Norris et al D Care v24 p ; Norris et al D Care v25 p ; Gary et al D Eduv29 p ; Care 2009; ICSI 2009; Norris et al D Care v24 p ; Norris et al D Care v25 p ; Gary et al D Eduv29 p ; Bray P, Thompson D, Wynn JD, Cummings DM, Whetstone L. Confronting Disparities in Diabetes Care: The clinical effectiveness of redesigning care management for minority s in rural primary care practices. J Rural Health (4):317-21;

5 Emotional support Y (4) Minimum of 1, as Nicotine dependence Y (1), N(1) Minimum of 1 Miscellaneous: Medications Y (1), N (3) Where appropriate Durable medical equipment N (3) Wellness and preventive services Y (2) Pancreas transplantation N (2) Diabetes prevention Y (1), N (2) Nursing home liaison N (1) Retinal photography N (1) Neurological testing Y (1), N(1) Minimum of 1 Clinical research program N (1) provider, nurse, provider, nurse, provider diabetes educator, dietitian diabetes educator, dietitian, exercise physiologist provider pt pt office visit Care 2009; ICSI 2009; McCulloch et al D Care v 17 p ; Care 2009; ICSI 2009; Haire- Joshu et al D Care v20 p ; ADA D Care v27 ps ; Nathan et al Clinical Diabetes v27 p4 2009; Boulton et a D Care v28 p ;

6 Spreadsheet Definitions 1. Scope- currently limited to uncomplicated diabetes with an age range that follows the ICSI guideline and references a specific list of exclusion. 2. Required component Y refers to a component that must be included in order to qualify as a basket for this topic; N indicates that component is not required as part of the basket. 3. Quantity in 1 year (if evidence supports frequency of service)- For example, AIc monitoring is required at designated periods throughout the year. This section identifies other services that have this same kind of required/recommended frequency. 4. Required provider type: specialty physician, provider, nurse, etc. For each component, as supported by evidence or consensus, this section limits its delivery to a subset of the potential providers. Where no limitation is specified, the provider could choose the provider type they deem most effective and efficient for the component. 5. Delivery modalities: classes,. This is where we can limit delivery modalities based on evidence or consensus and where there is no limitation, providers can choose the modality they deem most effective and efficient. 6. Rationale (source of evidence that supports position). Identified literature, guidelines, etc that specifically supports the inclusion of this component in the basket.