Challenges to implementing expanded team models: lessons from a centralised nurse-led cholesterol-lowering programme.

Area of Science:

• Cardiology
• Endocrinology
• Healthcare Management

Background:

• Lowering low-density lipoprotein (LDL) cholesterol is crucial for reducing morbidity and mortality in patients with diabetes mellitus (DM) and cardiovascular disease (CVD).
• Team-based quality improvement programs, involving registered nurses (RNs) adjusting medications, are increasingly used but implementation strategies require further understanding.

Purpose of the Study:

• To evaluate the experiences and lessons learned from implementing a centralized, expanded team-based quality improvement program for LDL cholesterol management.
• To assess the efficiency and success factors of a protocol-driven, registered nurse (RN)-led intervention for patients with DM and CVD.

Main Methods:

• Retrospective observational analysis of administrative and clinical data from a quality improvement program.
• Evaluation of primary care physician (PCP) and patient acceptance, medication adjustments, LDL cholesterol changes, and time to target.
• Analysis of program activities, including time spent on enrolled and non-enrolled patients.

Main Results:

• Of 374 identified patients, 203 were eligible, and 74% were accepted for enrollment by PCPs.
• Significant barriers included patient reachability (36%) and enrollment completion (50%).
• Enrolled patients (n=64) achieved a median LDL decrease of 21 mg/dL, with 52% reaching target; however, 44.4% of RN time was spent on non-enrolled patients.

Conclusions:

• Centralized, expanded team-based programs for LDL cholesterol management face significant efficiency barriers related to patient identification, enrollment, and engagement.
• While PCP support is valuable, substantial administrative efforts are required, indicating a need for infrastructure improvements to optimize team-based care delivery.