Clinical Review
The Triumphs and Tribulations of Establishing a Nurse-Run Chronic Disease Management Program in a Large VA Health Care Facility
Fed Pract. 2011 August;28(8):22
Author and Disclosure Information
Bryan W. Sisk, RN, BSN, MPH; Olawale Fashina, MD, MHSA; Cheryl Foster, RN, BSN, MSN; and Patricia A. Miller, RN, MSN.
Mr. Sisk is associate chief of the nursing service for ambulatory care; Dr. Fashina is associate chief of staff for ambulatory care; Ms. Foster and Ms. Miller both are nurse case managers for ambulatory care, all at Central Texas Veterans Health Care System in Temple. Mr. Sisk and Dr. Fashina hold faculty positions at Texas A&M Health Science Center in College Station.
Because it serves a large number of patients who struggle to cope with 1 or more chronic diseases, a VA health care facility is the prime setting
for a chronic disease management program (CDMP). Here,
the authors detail the challenges they experienced
while establishing a nurse-run CDMP at their facility.
The Veterans Health Care System is the largest health care organization in the United States which delivers care to a patient population that has a high prevalence of chronic conditions.1 The VHA is increasingly challenged to employ new methods to address critical health care issues. The VHA has instituted massive change and redesign within its organization since the 1990s. Between 1995 and 1999, numerous systemic changes were implemented that produced markedly improved quality, service, and operational efficiency.1