Glens Falls Hospital

Grant Status

Completed

Project Title

Sustainable Strategies for Diabetes Self Management

Award Amount

$172,771

Location

Glens Falls

Website

http://www.glensfallshospital.org/

Date Awarded

November 15, 2007

There are 23,858 diabetic patients in this high-need, rural area. This project will establish a diabetes registry across the Glens Falls Hospital network, re-design office visits to include integrated services, increase collaboration with community resources, and improve diabetes self-management among diabetic patients.

Project plans include implementing a disease registry in eight primary care practices. This system will include patient and physician reminders that will help providers prepare for office visits and will allow evaluation of physician performance based on the American Diabetes Association’s national standards. The project includes redesigning office visits to make them more coordinated for diabetes patients (involving a medical doctor, registered nurse, diabetes educator, and medical assistant team) and integrating a depression screening tool for diabetes patients. Patients identified with symptoms of depression will be referred to a behavioral health provider at Glens Falls Hospital and will be invited to participate in existing support groups for patients with depression and chronic conditions. Glens Falls will conduct patient focus groups and use the results to revise and inform self-management strategies. Glens Falls will use its longstanding relationships with community organizations (including libraries, school nurses, and volunteers) to extend efforts to promote nutrition and physical activity throughout the region.