Care Management Plan: A Newly Diagnosed Diabetic Patient

Type 2 diabetes mellitus is a growing disease in the United States. When developing a care management plan for new diabetic patient, several areas of education and resources should be considered. The purpose of this paper is to describe a hypothetical care plan for a newly diagnosed diabetic, including case management model used, initial and ongoing educational needs, and data collection and evaluation.

Case Management Model

Jane Doe has been diagnosed with type 2 diabetes postpartum. In order to provide continuous high quality care across the continuum, a diabetic case management plan will be needed. The plan will be the center of a diabetic case management team that adheres to a specific set of predetermined protocols and clinical care pathways (Cohen & Cesta, 2005). Members of the team will include a physician, nurse case manager, with the potential to consult a dietician, diabetic educator, and a social worker. This nonunit based multidisciplinary team approach ensures Jane Doe will receive care from experts in diabetes throughout her hospital stay as well as post discharge. The nurse case manager, along with the physician, will be responsible for developing an individualized plan of care. In addition, the nurse case manager will coordinate the recommendations from any additional team members that are consulted in a timely manner (Cohen & Cesta, 2005). The ultimate key to appropriate disease management is patient education; this is the tool that will empower Jane Doe to manage her diabetes successfully and to live a healthy, productive life.

Plan for Education

Initial

As with any new diagnosis, information about the disease process and treatment can be overwhelming for the patient. The early phase of educating J...

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... is the goal for Jane Doe.

References

American Diabetes Association. (2011). Diabetes superfoods. Retrieved from http://adap-sandbox.pub30.convio.net/food-and-fitness/food/what-can-i-eat/diabetes-superfoods.html

American Diabetes Association. (2011). Living with diabetes. Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care

Bowles, K., Holland, D., & Horowitz, D. (2009). A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management. Journal of Telemedicine and Telecare, (15), 344-350. doi: 10.1258/jtt.2009.090118

Cohen, E. L., & Cesta, T. G. (2005). Nursing case management: From essentials to advanced practice applications (4th ed.). St. Louis, MO: Elsevier Mosby.

Worth, T. (2010). Taking diabetes care to the community. American Journal of Nursing, 110(2)