Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Nancy W. Parker, RN, BSN, Adult Medical Center, San Francisco General Hospital, 1001 Potrero Ave., 1M40, San Francisco, CA 94110, 415-206-8708, nancy.parker@sfdph.org, Amalia D. Fyles, RN, CNS, CDE, General Medical Clinic, San Francisco General Hospital, 1001 Potrero Ave., 1M42, San Francisco, CA 94110, Ivonne McLean, UCSF/SFGH - Division of General Internal Medicine, San Francisco General Hospital, Box 1364, 1001 Potrero Ave., San Francisco, CA 94110, and Audrey Tang, RN, MSN, Division of General Internal Medicine, San Francisco General Hospital, 1001 Potrero Ave., Box 1364, San Fancisco, CA 94110.

San Francisco General Hospital (SFGH) is an urban county hospital serving a low-income, ethnically diverse population. 51% of our population has marginal to inadequate functional health literacy. SFGH has 2500 diabetic patients, 1500 of whom receive care in the General Medical Clinic (GMC). Only one third has achieved established treatment goals for diabetes care. Group visit education did not always meet the needs for patients, especially those with multiple diagnoses. Continued efforts to advance diabetic care throughout the system have lacked coordination. The purpose of this project was to utilize the nurse care manager role within a chronic disease model to improve the access and quality of care for patients with diabetes at GMC. Newly diagnosed and poorly controlled diabetics (HA1c >9.5) were stratified for management. Changes to the current delivery system were implemented, with greater emphasis on a patient-centered approach and multidisciplinary clinical teams. RNs were trained to take on an expanded role in chronic disease management using diabetes as a model. RN ownership of this new clinical role provided the greatest challenge, although the restructuring of a pre-existing nurse-run clinic eased the process. Changes were seen in patient self-management behavior as a result of negotiated goal setting during one on one sessions with the RN. Patient care guidelines were also defined, implemented and evaluated. Future goals include expansion of access and quality improvements to other chronic diseases, automated telephone diabetes management (ATDM) and enhancement of the medical group visit model.

Learning Objectives: At the conclusion of the session, the participant will be able to

• List the steps involved in program development
• Identify the challenges to new program implementation
• Recognize the role of RNs in chronic disease management

Presenting author's disclosure statement:

Not Answered

Handout (.pdf format, 159.3 kb)