Transcript Meeting the Challenge of Patient Centered Care: Diabetes
Meeting the Challenge of Patient-Centered Care: Diabetes Education
Roberta Eis, RN, MBA Sr. Program Manager, Diabetes Initiatives, HFHS Pamela Milan, RD, CDE, MBA Operations Manager, Diabetes Care Centers, HFHS
What is Diabetes Self-Management Education?
Diabetes Self-Management Education (DSME) is a crucial element of care for all people with diabetes DSME is necessary in order to improve patient outcomes National Standards are designed to assist diabetes educators in providing evidence-based information Henry Ford Health System has five “Diabetes Care Centers” offering DSME, using traditional educational approaches until 2008.
Why Change?
New national standards for Diabetes Self Management Education (DSME) were released in June 2007, new version expected in 2012. The new standards challenged American Diabetes Association (ADA) Recognized Programs to develop a curriculum delivered in a creative, patient-centered approach , encouraging patients set the agenda for their education.
Aim
To shift from primarily didactic presentation model to a facilitator style .
To standardized DSME class format allowing instructors to individualize the presentation to the groups as needed.
for all sites while To maintain the programs’ high customer satisfaction rating while aligning to the new process.
To develop curriculum exemplifying the use of action oriented, behavioral goals & objectives creative, interactive and patient-centered method of education.
delivered in a To maintain best practices from the established past curriculum: depression screening and education tool kits.
The Patient-Centered Education Model
Conversation Map ® educational tool Interactions, Inc. in conjunction with the ADA and supported by Merck & Co., Inc. was adopted.
created by Healthy Map is a large tabletop display tool with colorful visual images & metaphors, with printed cards is used to initiate various discussion topics.
The diabetes educator engages a group of patients seated around the map in interactive discussions and exercises .
The map is navigated sequentially with content specific to the DSME educational curriculum for each session.
Patients are central part of the learning process challenges in managing the disease. , and through the group model they discover and share many
Diabetes Conversation Map ®
Conversation Map ® Session
Teaching the Teachers
The change process evolved over time and required a tiered learning approach for the diabetes educators . All diabetes educators attended a half-day workshop provided by Healthy Interactions representatives on the introduction and use of the Diabetes Conversation Map ® in February 2008.
In the first groups attending this workshop, two educators embraced the new model and agreed to be early adopters . They piloted the curriculum at their site. A meeting was held with the entire DSME staff to gain team acceptance of the new teaching method.
Educators Still Not Ready
How ready are you to start using the Conversation Map tools as a stand-alone approach to patient education?
6 3 2 1 6 5 4 0 Not Ready 2 2 3 5 Very Ready Not Ready 2 3 Very Ready
Long Road to New Skills
The staff were encourage to attend the Taylor pilot site to observe classes which provided opportunity for on-site mentorship support .
In order to assist the staff with transitioning to facilitation of groups, Inc. a workshop on advance facilitation skills was conducted by a master trainer from Healthy Interactions, The staff still struggled with adaptation to the facilitation model, so multiple training sessions were provided on motivational interviewing .
Standardization and Best Practices
The standardized curriculum blended the best practices the traditional DSME of class content like education tool kits, practice with labels & food models and other hands on activities with the new education style .
Training in health literacy was completed. This knowledge was used as the basis for revising standardized patient education materials. Depression screening was a core component of DSME program that we wanted to maintain. After numerous iterations, we have now successfully incorporated depression screening in the initial assessment.
Maintain High Customer Satisfaction Scores
Satisfaction Survey Results Pre and Post Diabetes Conversation Map® Implementation
5.4
5.2
5 4.8
4.6
4.4
PRE POST 4.2
4
4.8
4.8
4.7
4.8
4.7
4.8
4.8
4.8
Likert Scale:
1 to 5
90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Improved Patient Engagement in Classes
Average Class Completion Rates for the Diabetes Care Center Sites Pre and Post Diabetes Conversation Map Implementation
Pre Post
74% 83% 75% 82%
Sites were less than 1 year in operation – mixed model to start not totally didactic.
68% 80% 62% 82% 53% 71% 65% 80%
Taylor Sterling Heights Fairlane Columbus New Center Program
15% Increase in Class Completion
20% 18% 16% 14% 12% 10% 8% 6% 4% 2% 0%
% Change in Completion Rates after Diabetes Conversation Map Program Implementation
20% 18% Three years after change 9% 7% 12% 15% Taylor Sterling Heights Fairlane Columbus New Center Program
Patient Centered Care Patients teach each other:
– We can hold up a divided plate to discuss portion sizes, but when a patient shares his personal weight loss story by using the small plate his wife started a month ago, the impact is much greater.
Patients support/bond with each other:
– At one site the group set up an email based support group.
Participant Behavioral Outcomes 2010
N = 553 Healthy Eating Being Active Monitoring Taking Medications Problem Solving Healthy Coping # who Selected Goal # Reporting Success 248 210 27 9 5 181 126 23 8 5 % Met Goal 73% 60% 85% 89% 100% Benchmark 60% 60% 60% 60% 60% 8 5 63% 60% Reducing Risk 32 23 72% 60% Unknown 14 10 71% 60%
Behavior goal categories based on AADE7 Self-Care Behaviors ™
Self Reported Behavior Change 2010
N = 313 Testing your blood sugar level Handling your stress or coping Taking your medications as directed Caring for your feet Eating smaller portions Your amount of activity/exercise Your amount of smoking Less Often 21 10 5 5 18 18 18 No Change 137 More Often 146 163 173 130 70 131 109 131 108 167 214 152 6 # of responses 304 304 286 302 302 301 133 % of more often 48% 43% 38% 55% 71% 50% 5% Keeping doctor appt every 4 to 6 months Yes 293 No 8 # of responses 301 % of yes 97%
Impact of Diabetes Education
Patient Feedback
“Learning from other patients with diabetes like myself and being able to discuss my concerns was very helpful.” “The other participants made the classes fun and interesting. It’s good to know we are not alone.” “These classes told and helped me learn about things that my doctor could not have done for me. Thank you!!”
Lessons Learned
Accept that change is evolutionary and takes time, especially when staff are entrenched in the current process. Communication and engagement skills, positive reinforcement and patience are crucial.
Realization that staff who have developed a lifelong teaching style need to be thoroughly trained in a new style of education.
“ Early adopting ” colleagues made the best trainers for the process.
Teamwork is essential education curriculum.
in providing quality patient care. Collaboration between nurses, dietitians, behavioral nurse practitioners and management was essential to the development of appropriate evidence-based diabetes
Lessons Learned
The patient ’ s agenda for learning needs to be considered in the development of an education program. The Conversation Map ® environment of learning, allows patients to learn from each other and results in more enthusiasm with the information delivered.
Attempting a new approach that fostered engagement trumped the inclination to remain static, i.e., “ We ’ ve always done it this way ” . A consistent, standardized approach results in more reliable, replicable outcomes and increased transportability of the program .
Continuous Improvements Since Implementation
Establish a Peer Review process to maintain consistency throughout the Diabetes Care Centers.
Share class completion rates to investigate trends for process improvement with DSME Staff each month.
The program has changed patient feedback surveys & program follow up to reflect the patient-centered, healthy behavior questions.
Continue to collect data to look for additional ways to improve diabetes outcomes .
Continue tracking race, sex, gender data to look for trends in healthcare disparities and possible program improvement.