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Diabetes Management Service

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DIABETES MANAGEMENT SERVICES(DMS)

DMS MODEL

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DMS Model

The model we have developed for the Diabetes Management Service (DMS) consists of a medical director (Dr. Annabelle Rodriguez, a board-certified endocrinologist), nurse practitioner(s), certified diabetes educator(s), pharmacist(s), and data analyst(s).

The major focus of the DMS is for the nurse practitioner (NP) to actively manage the daily blood glucose levels with medication adjustment. In our model, a consultation is generated by the primary team via a computer order entering system. Once the NP is apprised of the consultation, he/she performs a comprehensive examination of the hospitalized patient. The NP is equipped with a wireless laptop that contains a comprehensive Microsoft Access® database (which we developed specifically for patients with diabetes and is available for purchase). Once the NP has completed the initial consultation, he/she is able to print out the forms for the medical chart while simultaneously updating the database. Maintenance of the database was approved by the Johns Hopkins Institutional Review Board and the database forms were approved by the Johns Hopkins Bayview Forms Committtee. The NP evaluates patients on a daily basis during the course of their hospitalization. In addition, to insure continuity of care, the NP sees discharged and new patients two half-days per week in an outpatient endocrinology office adjacent to the main hospital.

The certified diabetes educator also is equipped with a wireless laptop that contains a comprehensive Microsoft Access® database that we specifically developed as an educational tool for hospitalized patients with diabetes mellitus (this database can also be purchased separately from the NP database). The certified diabetes educator works in a collaborative manner with the NP, and together a plan is developed to educate patients and health care providers regarding the best practices for diabetes care.

The pharmacist is an invaluable member of the DMS team. This person serves as an important liaison with the Pharmacy and Therapeutics Committee. In our experience, the pharmacist was extremely helpful in improving insulin sliding scales, insulin infusion protocols and hypoglycemia protocols.

The data analyst is also an invaluable member of the DMS team. The responsibilities of the data analyst included development and maintenance of the two databases, and well as integration of data derived from the hospital's databases. Monthly reports are generated which target outcomes such as length of stay, case-mix index, readmission rates for patients with diabetes mellitus, co-morbidities and the downstream impact to the institution.












Dr. Annabelle Rodriguez, M.D.
Director


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