chronic care – Minimally Disruptive Medicine

Repost from Linkedin with permission from Jerry Penso

For the past year, I have been exploring strategies for diabetes care improvement with The American Medical Group Foundation (AMGF), planning our next national campaign to address this chronic disease. As a result I have had many conversations with national diabetes experts, medical group endocrinologists, primary care physicians, and quality improvement specialists. In AMGF’s first national campaign, Measure Up/Pressure Down®, we promoted systematic care delivery improvements to improve high blood pressure detection and control. With the aid of this improvement framework, teams were able to figure out what to improve, measure it, and test changes in the system to see if they made a difference. Our goal is to create the same kind of targeted improvement in the care of diabetes.

Recently, I became familiar with two AMGA members that are demonstrating outstanding performance in diabetes management: Cornerstone Healthcare, PA, in North Carolina and Geisinger Health Systems in Pennsylvania. These two health systems have achieved better quality for tens of thousands of patients with diabetes through careful workflow redesign—automating manual work, delegating duties to non-physician staff, standardizing treatment algorithms, and measuring key outcomes to report back to their physicians. These efforts have made quantifiable reductions in complications due to poorly controlled diabetes, including diabetic retinopathy, heart attacks, and strokes.

Two conversations in the past month have begun to alter my thinking about AMGF’s upcoming campaign. One was with Lorraine Stiehl, Consultant, Stiehlworks and Board Member, JDRF who is an advocate for people with diabetes and also works closely with organizations that promote patient empowerment, like diaTribe and Diabetes Hands. What struck me after talking with Ms. Stiehl was the tremendous yearning among patients for better conversations about the day-to-day existence living with diabetes. They look to their healthcare professionals for information, care, and support, yet many are not finding the current system responsive to their daily needs. So many are turning to social media in greater and greater numbers to address these unmet needs, especially emotional support.

I was also impressed by a conversation with Dr. Victor Montori, an endocrinologist who serves as director of late-stage translational research for the Mayo Clinic Center for Clinical and Translational Science. Dr. Montori is a leading proponent of minimally disruptive medicine (http://minimallydisruptivemedicine.org), an approach that seeks to advance patient goals for health, health care, and life. He emphasized the need for care teams to design interventions that respect the capacity of patients and caregivers, and systematically reduce the burden of treatment. Today’s diabetes care increasingly involves complex treatment regimens, yet these recommendations often ignore the tremendous burden this places on a patient with chronic conditions.

The question I now ponder is how we move the needle for populations of patients with diabetes, while honoring our patients’ personal needs, wishes, values, and capacity for change. We’ll want to promote systemic, standardized approaches to performance improvement because we know many patients with diabetes are not at optimal target range and are at risk for serious complications. At the same time however, we must continue to be vigilant in developing interventions that do not create undue burdens or unrealistic expectations for patients, care teams, or health systems.

Jerry Penso