-Carole’ Mensing RN, MA, CDE, FAADE Manager of Clinical Education Programs, Joslin Diabetes Center -Christine Tobin RN, MBA, CDE Diabetes Management Solutions.
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-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
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.
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
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
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”
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).
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