-Carole’ Mensing RN, MA, CDE, FAADE Manager of Clinical Education Programs, Joslin Diabetes Center -Christine Tobin RN, MBA, CDE Diabetes Management Solutions -Nora Saul, RD, LD, CDE Nutrition, 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 Active  Healthy Eating  Taking Medication  Monitoring  Problem Solving  Reducing Risks  Healthy 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  % 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%

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 Coping3  Healthy Eating21  Monitoring 18  Phys Activity19  Prob Solving5  Risk Reduction19  Take Meds7  All %

Goal # Category # no% no  Healthy Coping 3  Healthy Eating21  Monitoring18  Phys Activitiy19  Prob Solving 5  Risk Reduction19  Take Meds 7  All Combined

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

Cont.  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 Data 3. Analyze the Data 4. Identify Alternative Solutions 5. Develop Implementation Plan 6. Implement the Plan 7. Evaluate the Actions 8. Maintain the Improvement CQI : A Step by Step Guide for Quality Improvement in Diabetes Education. AADE (2008).

 Improve our outcomes language  Clear understanding of the Education Process: - Assess  Plan  Implement  Evaluate  Follow up  Establish Process - setting goals, measuring achievement- documentation- using the information for improvement!