Background

Literature Review

Ida Jean Orlando’s 1961 Nursing Process Theory

Implications, Recommendations , & Relevance to Nursing

Measurable/Targeted outcomes

Projection Description

Conclusion

A Telehealth Integrated Chronic Care Management Model (CCM) for Type II Diabetes

Ryan E. Baumgartner, B.S.N., R.N.Xavier University College of Nursing

Purpose

Planned Evaluation

DiscussionChange Theory

This theory offers nurses guidance for framing care delivery

models when circumstances require technology in nursing

practice.

The development of new nursing practices to include modern

technologies is essential for overcoming barriers to patient care.

In Orlando's theory, the nurse's role is to seek out and meet the

patient's immediate needs. As the pandemic has restricted access to

care, patients experience distress in not having their needs met.

Using these principles, an approach to remote diabetic care allows

the nurse to appropriately and promptly respond to the patients'

needs has been framed (Alligood, 2018).

Telemedicine has become a critical strategy to improve access

to diabetes care during the CoVID-19 Pandemic.

The CoVID-19 Pandemic has socially distanced the public and

changed operations at the Cincinnati Health Department

(CHD).

Adjustments in the delivery of essential patient care had to be

made and routine office appointments for CCM were

suddenly canceled.

CHD’s leadership searched for innovative models for

providing remote diabetic care that is cost-effective, efficient,

and safe.

This project aims to develop a chronic care management

(CCM) model that integrates telehealth services for the

delivery of nursing care to the type 2 diabetic (DM2) patient.

The overarching goal is to have this model adopted and

implemented into practice at the Cincinnati Health

Department (CHD).

A well-developed and effective diabetes care management

model's objective is to control blood glucose.

This objective can be accomplished in two ways using

telehealth as the delivery platform.

Healthy lifestyle modification, including dietary changes,

regular physical exercise, weight reduction as specified by

the nurse

Provide medication management.

This literature review identified and evaluated high-quality,

evidence-based practices (EBP) in scholarly articles, reviews,

studies, and meta-analyses, providing evidence that the

combination of telehealth technologies with diabetic CCM

could be a practical approach to managing glycemic control in

the DM2 patient remotely.

The three databases used most frequently in this literature

search were PubMed, MEDLINE, and CINAHL, using the search

words telehealth, chronic disease, patient education, and related

concepts.

Sufficient evidence supporting these tenets was uncovered,

suggesting developing a telehealth-integrated CCM model for

the DM2 patient will be effective, cost-efficient, and safe while

improving patient outcomes and clinical practices.

This review examined citations from government websites that

provided research strategies for finding clinical studies, EBP, and

systematic reviews.

The Delivery System Design element of the Tele-CCM Model

assures efficient, effective care and self-management support

(Gee et al., 2015).

This element comes with five change concepts. These concepts

are foundational to the structure of the Tele-CCM Model. They

include the following: a) define roles and distribute tasks

among team members, b) use planned interactions to support

evidence-based care, c) provide clinical case management

services for complex patients, d) ensure regular follow-up by

the care team, and e) give care that patients understand, and

that agrees with their cultural background.

These concepts provided a framework for structuring the

diabetic care management component of this new Model.

Like the Tele-CCM Model developed for this project, previous

models aimed to improve clinical outcomes, patient experience,

nurse/provider satisfaction, and reduce costs (Ali et al., 2013).

When the Tele-CCM Model is adopted and implemented, CHD

administration can expect improved patient outcomes.

These improvements can be used to monitor plan objectives using

the HRSA quality measures to benchmark project progress.

HRSA endorsed the IOM to examine the potential of telehealth

care delivery services over two decades ago. One of these metrics

included the Hgba1c.

Point-of-Care HgbA1c’s will be collected on-site every 3 months.

When reductions in this value are observed in patients provided

with Tele-CCM nursing services, it will indicate the successful

implementation of the Model.

Harrison’s Model illustrates the

relationship between culture,

behavior, technology, and

structure related to external

forces. The organization must use

what resources (input) they have

available to them and incorporate

them (telehealth) into their

processes (diabetes care) to

provide essential patient services

(output). From Touson et al.

(2021). Harrison’s Model applied to

Orlando’s Nursing Process

Theory (below).

Utilization: Tracking of nurse telehealth encounters will be

reported once a week. The site champion will also be the CCM-

C. Initially, the target goal will be ten completed Tele-CCM at

each health center (one nurse) per week. The target goal will

increase incrementally as the nurse uses the new care model.

Clinical Outcomes: Baseline values should be noted before the

initial Tele-CCM visit, and these values should be reevaluated at

three-month intervals. When reductions (improvements) in

these values are observed, program effectiveness can be assumed

Profitability: Benchmarking clinical improvements and outcomes

with metrics meet HRSA quality standards. When these

standards are met, the organization is awarded federal funding.

User Satisfaction: Feedback from point-of-care providers and

patients is critical (McGlynn et al., 2012). Semiannual surveys

will be distributed to patients receiving Tele-CCM and the nurses

who provide it. These surveys will be anonymous.

As other industries seamlessly moved to virtual interactions,

healthcare organizations, like the CHD, are continually

challenged with their obligations to provide patient care in a

virtual capacity.

The organization’s leadership continues to search for

innovative models for delivering remote diabetic care that is

cost-effective, efficient, and safe to the population they serve.

Future adoption of the Tele-CCM Model by CHD leadership,

coupled with stakeholder participation, will allow the CHD to

deliver a much-needed service to those socially distanced

populations further removed from access to care by the

pandemic restrictions.

In a recent study (ADA, 2021) 2,500 individuals with DM2 found

that 9% of respondents said they could not afford medical care

during the pandemic.

One in five people said they had foregone getting an insulin pump or

continuous glucose monitor (CGM), attributing financial strain.

15% of people with diabetes who rely on management technologies

like pumps or CGMs have delayed refilling diabetic testing supplies

and needles during the pandemic;

70% of these respondents, this was also due to financial strain.

12% of people with diabetes have experienced a disruption in

insurance coverage since the start of the pandemic; of those who lost

coverage due to the pandemic, half could not regain coverage.

In a related survey (Solberg et al. 2021), researchers found that

despite these setbacks faced by the DM2 population during the

pandemic, many have appeared to benefit from increased access and

use of telehealth services.

73% percent of people with DM2 have used telehealth services

during the pandemic, compared to 11% before CoVID-19. Of those

who have utilized telehealth, 40% report that it has made it easier to

manage their diabetes, compared with 37% who reported no change.

36% say they plan to continue seeking health care remotely after the

pandemic (Solberg et al., 2021).

Nurse Tele-CCM visits offer a broader reach to

the larger communities. Giving nurses the ability

to manage diabetic care via telehealth can

maintain the patient-provider relationship.

It also is an avenue by which nurses can

reestablish relationships between the CHD and

members of the community lost to care in the

wake of the pandemic (Fursse et al., 2008).

The Tele-CCM Model can guide tentative

payment structures that manage the current

national state of emergency and help prepare

the CHD’s financial officers to negotiate for

future payor reimbursement plans (Rittenhouse

& Peikes, 2020).

Tele-CCM Services Model for Diabetes Type II

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