Diabetes educators and the patient-centered medical home

The patient-centered medical home is a term that we have been hearing with increasing regularity lately. Although the concept has been around since 1967 and was originally applied to coordinated pediatric care, it was recently expanded to encompass patients in all stages of their lives with many health care needs.

Basically, the current medical home concept calls for patient-focused, personalized care that is coordinated and overseen by a primary care physician. It is meant to address the inadequacies of the current health care system by improving the patient-physician relationship and making the primary care practice environment the centralized location for all of the patient’s medical needs — including acute, chronic and preventive services. A medical home also emphasizes enhanced care through electronic medical records, evidence-based guidelines, open scheduling, expanded hours and better communication between patients, physicians and staff.

Donna Tomky

Exploring new opportunities

Because the medical home concept is gaining traction in the greater health care community, it is critical that we explore the opportunities that arise for health care professionals who deliver care to patients with diabetes.

The American Association of Diabetes Educators has long supported the team-based approach to diabetes care and asserts that diabetes educators are important members of the care team who provide evidence-based, patient-centered care to people with diabetes.

Self-care training and support is essential for the successful outcomes of patients with diabetes and other chronic illnesses. AADE’s Practice Advisory, “The Medical Home and Its Importance for the Diabetes Educator,” contends that educators help physicians implement and carry out care plans and that it is important that they be included as a key member of the patient-centered medical home (PCMH) team.

Providing self-care support and community resources is one of the standards that prospective medical homes must meet to be recognized by the National Committee for Quality Assurance. Therefore, there is a great opportunity for diabetes educators to be fully integrated into the everyday workings of a medical home.

AADE project

Currently, AADE is exploring the feasibility of incorporating a multilevel diabetes education team (See chart) into the PCMH model through a demonstration project. The objectives of the project are to:

• Advocate and achieve full integration of diabetes educators into the PCMH diabetes care team.
• Demonstrate the effectiveness of a multilevel diabetes self-management education and training team within the PCMH model.
• Assess economic and operational feasibility, strength and weaknesses of this type of integration.
• Monitor the clinical, behavioral and utilization results that are associated with the provision of diabetes self-management education and training in this context.

Specifically, the demonstration project will include six or seven sites at different stages of becoming a PCMH. The sites will cover a multitude of settings, from universities to larger multisite medical centers. A diabetes educator, who may serve or work at one or more sites/clinics, will be a designated member of the PCMH team and will be fully integrated into the care of patients with diabetes. In addition, community health workers will be included in the team, as well as other health care professionals. Emerging payment options for medical home services (such as capitation, bundled payments and fee-for-service) will also be explored during the demonstration project.

Potential of the medical home

The PCMH concept has the potential to greatly extend the effectiveness of the care provided to patients. It can offer better coordination with specialty practices and could significantly improve the data-sharing process among the continuum of care. Many questions remain, however.

It is still unclear whether the medical home has the ability to deliver the quality care, coordination and reduction of health care costs and utilization that the advocates of the model are promising. According to the AADE Practice Advisory on medical homes, some of these concerns are directly related to whether this can be accomplished in a system with so few PCPs, physician extenders such as diabetes educators and a lack of technological resources to allow the medical home model to succeed on a national level.

Despite these reservations, the medical home concept deserves serious consideration. More research and data are needed to determine whether this is a sustainable model, and it is, therefore, beneficial to examine how diabetes educators can fit into the model early-on in its development.

Donna Tomky, MSN, RN, C-NP, CDE, is president of the American Association of Diabetes Educators.