Providers’ Perspective on Diabetes Case Management: A Descriptive Study

There are limitations to our study. First, we did not pilot the survey we used in the study. Piloting is important to ensure the questions are clear and are not misleading. Second, this study may be unique to Minneapolis Veterans Heath Care system (VA) providers, who generally treat an older population of veterans with several comorbidities, and hence their views could differ from those of the providers outside the VA practice. The VA system does not have the typical fee-for-service construct, and therefore the likelihood of acceptance may be higher because case managers are not perceived as competition. In addition, the impact of CM on physician reimbursements could not be determined. Third, when analyzing provider responses, we were unable to account for the individual patient outcomes in the study. Lastly, the inherent limitation of using the Likert scale is the central tendency bias and social desirability bias where the providers portray themselves in a more favorable light which may not represent their true views.

Key problems with CM implementation for different disease models have been reported to be uncertain identities¹⁵ and relationships within a practice team.¹⁴ Our study contradicts this concept and indicates that neither factor is a barrier to global implementation of CM in diabetes. This is consistent with the results of the study by Taylor et al.¹³ However, it is imperative that our results are confirmed in fee-for-service healthcare settings prior to global implementation of CM.

The study case managers (an NP and an RN who was also a Certified Diabetes Educator) were highly experienced in managing patients with diabetes. Whether our findings would be replicated with less-experienced case managers is unknown.

CM has been demonstrated to improve CV risk factors. Patients have greater satisfaction with CM. The present study demonstrates that CM also improves physician satisfaction.

Author Affiliations: From VA Health Care System (NE-F, NG, AI), Minneapolis, MN; Department of Medicine (NE-F, KG, AI), University of Minnesota, Minneapolis, MN; Center for Chronic Disease Outcome Research (NG), Minneapolis VA Health Care System, Minneapolis, MN.

Funding Source: This study was funded by a Veterans Integrated Service Network 23 Grant.

Author Disclosures: The authors (NE-F, KG, NG, AI) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (NE-F, KG, NG, AI); acquisition of data (NE-F, KG, NG, AI); analysis and interpretation of data (NE-F, KG, NG, AI); drafting of the manuscript (NE-F, KG, AI); critical revision of the manuscript for important intellectual content (NE-F, KG, NG, AI); statistical analysis (NE-F, KG); provision of study materials or patients (NE-F, NG); obtaining funding (NE-F, AI); administrative, technical, or logistic support (NG); and supervision (NE-F, AI).

Address correspondence to: Nacide Ercan-Fang, MD, Associate Professor of Medicine, University of Minnesota, Metabolic Staff Physician, VA Medical Center, 1 Veterans Dr 111G, Minneapolis, MN 55417. E-mail: Ercan001@umn.edu.

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