-Carole’ Mensing RN, MA, CDE, FAADE Manager of Clinical Education Programs, Joslin Diabetes Center

-Christine Tobin RN, MBA, CDEDiabetes Management Solutions

-Nora Saul, RD, LD, CDENutrition , Joslin Diabetes Center

Review Documentation of Collaborative Goal Setting- Identify Patterns, Trends

Assess the Current Goal setting and outcome Measurement Practice

Identify Improvement Opportunities thru CQI

Hypothesis◦ Process vs Outcome

Completed Comprehensive Program Return for Follow Up Five charts per Educator Match pt for part 1 and 2, de-identify Send/ mail Original, keep a copy

Ah Ah! Training Issue

Goal, objective Behavioral plan/Action plan Educational Plan/ Treatment Intervention Behavioral Goal Setting/ Problem Solving Behavioral Goal Change/ Change Sheet Setting goals/ Collaborative Goal Setting Comprehensive Program Completion

Simple Descriptive, Process Design

Retrospective

Sample Design

AADE 7

Everything and Anything is part of a process

Quality is more than conformity

Addresses root causes not symptoms

Improve the process to solve the problem!!!

Remember 90% of the problems are the process, not the people.

Being ActiveHealthy EatingTaking MedicationMonitoringProblem Solving Reducing RisksHealthy Coping

Patient / Client

SMART-Specific, Measurable, Achievable, Realistic, Timebound

Reviewed with each encounter – determine achieved, progress made, LTF, or revised.

Individualized

In God we trust…

In all others, bring data

2009 (2008) 2010 (2009)

# patients- 457

# goals- 1006

% LTF- 23

# patients- 417

# goals- 775 (1034)

% LTF- 22

Analyze

◦ Data Collection – audits part 1 and 2

◦ Goal Setting categories

◦ By site, using the Handout 2009 Site Specific Achievement Data form.

Monitoring

Eating Healthy

Physical

Activity

Taking Medication

Problem Solving

Healthy Coping

Risk Reduction Healthy Eating 35%

Physical Activity 21%

Monitoring 20%

Risk Reduction11%

Taking Medication 7%

Problem Solving 5%

Healthy Coping 2%

% Achieve 1 (Never)

2 (Rarely)

3 (Sometimes)

4 (Usually)

5 (Always)

Always 35%

Usually 30%

Sometimes 22%

Rarely 8%

Never 5%

Breakdown by Achievement Level

***********************

Big 3 67%

Risk Reduction 1.3%

76% (increase)

11% (increase)

*******************

Healthy Coping 3 Healthy Eating 21 Monitoring 18

Phys Activity 19 Prob Solving 5 Risk Reduction 19 Take Meds 7 All 92

3100%2 103 173 162 404 212 2919 21

Goal # Category # no % no

Healthy Coping 3 Healthy Eating 21 Monitoring 18 Phys Activitiy 19

Prob Solving 5 Risk Reduction 19 Take Meds 7 All Combined 92

3 10020 9516 8915 79

5 10019 19 5 7183 90

Learn from the mistakes of others. You won’t live long enough to make them all yourself.

Part 1-DSMS- what is this? (Criteria/ template)

Documentation better PCP Communication at Follow up needs

improvement (describe goal) Part 2-Same goals for all pts Several goals/ all 7 categories covered Allowed only one goal “Most goals not individualized”

HC- “Follow MP, check 1x daily and check feet”

HE- “Will eat 3 meals and 3 snacks a day”

M- “Use electronic Glucose Log daily and review records weekly”

PA- “Exercise 20” daily once leg heals

PS- “Identify Potential problems” RR-“Follow MP, check 1x daily, check feet daily”

Med- “med with meals as physician ordered”

Next……………

Develop a Plan

Implement the Plan

Critical Thinking

1. Identify the Problem/Opportunity

2. Collect the Data3. Analyze the Data4. Identify Alternative

Solutions5. Develop Implementation

Plan 6. Implement the Plan7. Evaluate the Actions8. Maintain the

ImprovementCQI : A Step by Step Guide for Quality

Improvement in Diabetes Education .

AADE (2008).

Improve our outcomes language

Clear understanding of the Education Process:

- AssessPlanImplement EvaluateFollow up

Establish Process - setting goals, measuring achievement- documentation- using the information for improvement!