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Enhancing the Patient Experience with Follow-Up Diabetes Care while Increasing Efficiencies Using Quality Improvement Methods
Abstracts / Can J Diabetes 40 (2016) S27–S74
77 Moving On. . .with Diabetes: Transition Education Program for Parents/Caregivers of Youth/Young Adults with Diabetes NATALIE SULLIVAN*, PEGGY DUNBAR, GERARD MURPHY† Halifax, NS Background: Parents*want to ensure their child “lands safely” in the adult care world and as a result must be part of the preparation and integration phases for successful transition. They also have specific needs that should be addressed as the transfer of care approaches. Aim: To meet the need of parents in the development of an information module, we articulated overarching principles, as follows: content must be needs-based, include first-voice experiences and information about transition processes and materials with a clear understanding of the parents’ role throughout transition, be developed for delivery/facilitation by interested healthcare providers and/or parents, and encourage engagement and interaction. Methods: A telephone interview guide was developed using 16 questions. Interviews were conducted with 7 parents. Eight themes emerged forming the basis for the information module: feelings experienced, issues and concerns about transition, questions parents have about transition, what parents need to know, what parents need to do, perceived support needs, perceived supports available and wise words for healthcare providers. A 2-part module was created. Part 1: Awareness for parents of youth ages 13 to 15 years; Part 2: Facilitated session for parents of youth/young adults ages 15 to 18 years. Supporting materials include a facilitator’s guide, participant materials, slide decks, learning aids and social media posts. Conclusions: First voices of parents interviewed were essential in shaping the content of our sessions. The first session was delivered in spring of 2016 with revisions pending. This information module will be made available across the province starting in the fall of 2016. *Parents/caregivers
78 Feasibility and Effectiveness of Peer Diabetes Health Coaches PATRICK MCGOWAN*, FRANCES HENSEN Delta, BC Purpose: People with diabetes experience difficulty in managing, and ongoing interaction with clinical staff is hard to obtain. This pilot was a partnership between the University of Victoria (U Vic) and 11 diabetes centres (DC). Methods: U Vic recruited and trained 100 coaches with various backgrounds. Coaches had type 2 diabetes and had taken a selfmanagement program. Training included information on type 2 diabetes, behavioural change strategies and navigating the healthcare system. One hundred-fifty subjects with type 2 diabetes were recruited. Eligibility criteria included adults with type 2 diabetes, attending a DC, experiencing difficulty managing and ability to speak English or Punjabi. A one-way repeated-measures analysis of variance was used with 14 measures (A1C, activation, empowerment, self-efficacy, self-reported health, fatigue, pain, depression, communication with physician, medication adherence, health literacy, emergency department visits and nights in hospital in the previous 6 months) obtained at baseline, and at 6 and 12 months. Qualitative research methods were used to gather perspectives and opinions from subjects, coaches, diabetes educators and members of a community advisory committee. Results: In addition to improvements in outcome measures, the pilot obtained valuable information on recruiting diabetes coaches and participants, training coaches, pairing coaches with participants, length and intensity of the intervention, liaising with diabetes health professionals and monitoring and supporting coaching integrity. Conclusions: The pilot demonstrated that diabetes peer coaching is viable, effective and certainly has a role in the spectrum of ongoing
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diabetes care. The lessons from the pilot also provided valuable information to peer coaching in general. 79 Enhancing the Patient Experience with Follow-Up Diabetes Care while Increasing Efficiencies Using Quality Improvement Methods MARGARET DE MELO, PHILLIP SEGAL, ELAINE WYLIE, ANN MURPHY Toronto, ON Background: The rapid rise in the prevalence of diabetes and its ensuing healthcare costs has galvanized the need to pursue quality improvement strategies that improve efficiency. Objective: To improve efficiency and enhance patient experience in follow-up diabetes care. Design and Methods: Quasi-experimental mixed method was used with concurrent, non-randomized controls from a sister site within 2 tertiary academic endocrinology clinics. Direct observation and rapid improvement cycles were used to study and improve workflow and teamwork of a 3 monthly shared medical appointment (SMA) for follow-up adult patients with diabetes on insulin therapy, facilitated by a nurse, dietitian, endocrinologist and a patient volunteer. Quantitative and qualitative data on patient experience, time spent per patient per month, care plans and staff satisfaction were analyzed. Results: Preliminary results reveal psychological safety and shared internal conflicts as themes of enhanced patient SMA experience, which suggest increased staff satisfaction and integrated care plans of all patients, and circa 75%, 64% and 33% efficency gains per patient for follow-up diabetes care for nurse, dietitian and endocrinologist, respectively, compared to usual 1-1 care. Limitations: Results are not generalizable as a convenient sample of patients were offered the intervention. Despite internal validation and corroboration of results, potential biases exist. Run charts could not be objectively analyzed for evidence of non-random signals of improvement due to insufficient data points. Conclusions: An SMA for the provision of follow-up care is a potentially efficient alternative to 1-1 care and can enhance the patient experience. 80 Dietetic Referrals in Various Primary Healthcare Settings: A Literature Review STÉPHANIE ABOUEID*, IVY LYNN BOURGEAULT*, ISABELLE GIROUX* Ottawa, ON Obesity is multifactorial and contributes to many chronic diseases, such as type 2 diabetes. Individualized nutrition counselling by a dietitian has been shown to be effective in aiding patients with weight loss and management. Dietitian services are not publicly funded but are offered free of charge in team-based clinics, with a referral from a family physician (FP) or nurse practitioner (NP). The objective is to evaluate the use of dietetic referrals in different types of primary healthcare settings. Databases include Scopus, Cochrane, EMBASE, Science Direct and PubMed. The search retrieved 310 citations. Inclusion criteria: 1) primary care settings, 2) dietetic referrals, 3) adult patients, 4) article published from 2000 onwards and 5) quality. This resulted in 20 articles to be included in this review. Irrespective of the type of primary healthcare setting, there seems to be suboptimal use of dietetic referrals. However, referrals in team-based clinics are more likely due to having a dietitian in proximity, which promotes relationship building and interprofessional collaboration. Similarly, referrals are more used in rural clinics where primary care providers have less support from members of their own profession compared with urban areas. This factor and the
77 Moving On. . .with Diabetes: Transition Education Program for Parents/Caregivers of Youth/Young Adults with Diabetes NATALIE SULLIVAN*, PEGGY DUNBAR, GERARD MURPHY† Halifax, NS Background: Parents*want to ensure their child “lands safely” in the adult care world and as a result must be part of the preparation and integration phases for successful transition. They also have specific needs that should be addressed as the transfer of care approaches. Aim: To meet the need of parents in the development of an information module, we articulated overarching principles, as follows: content must be needs-based, include first-voice experiences and information about transition processes and materials with a clear understanding of the parents’ role throughout transition, be developed for delivery/facilitation by interested healthcare providers and/or parents, and encourage engagement and interaction. Methods: A telephone interview guide was developed using 16 questions. Interviews were conducted with 7 parents. Eight themes emerged forming the basis for the information module: feelings experienced, issues and concerns about transition, questions parents have about transition, what parents need to know, what parents need to do, perceived support needs, perceived supports available and wise words for healthcare providers. A 2-part module was created. Part 1: Awareness for parents of youth ages 13 to 15 years; Part 2: Facilitated session for parents of youth/young adults ages 15 to 18 years. Supporting materials include a facilitator’s guide, participant materials, slide decks, learning aids and social media posts. Conclusions: First voices of parents interviewed were essential in shaping the content of our sessions. The first session was delivered in spring of 2016 with revisions pending. This information module will be made available across the province starting in the fall of 2016. *Parents/caregivers
78 Feasibility and Effectiveness of Peer Diabetes Health Coaches PATRICK MCGOWAN*, FRANCES HENSEN Delta, BC Purpose: People with diabetes experience difficulty in managing, and ongoing interaction with clinical staff is hard to obtain. This pilot was a partnership between the University of Victoria (U Vic) and 11 diabetes centres (DC). Methods: U Vic recruited and trained 100 coaches with various backgrounds. Coaches had type 2 diabetes and had taken a selfmanagement program. Training included information on type 2 diabetes, behavioural change strategies and navigating the healthcare system. One hundred-fifty subjects with type 2 diabetes were recruited. Eligibility criteria included adults with type 2 diabetes, attending a DC, experiencing difficulty managing and ability to speak English or Punjabi. A one-way repeated-measures analysis of variance was used with 14 measures (A1C, activation, empowerment, self-efficacy, self-reported health, fatigue, pain, depression, communication with physician, medication adherence, health literacy, emergency department visits and nights in hospital in the previous 6 months) obtained at baseline, and at 6 and 12 months. Qualitative research methods were used to gather perspectives and opinions from subjects, coaches, diabetes educators and members of a community advisory committee. Results: In addition to improvements in outcome measures, the pilot obtained valuable information on recruiting diabetes coaches and participants, training coaches, pairing coaches with participants, length and intensity of the intervention, liaising with diabetes health professionals and monitoring and supporting coaching integrity. Conclusions: The pilot demonstrated that diabetes peer coaching is viable, effective and certainly has a role in the spectrum of ongoing
S29
diabetes care. The lessons from the pilot also provided valuable information to peer coaching in general. 79 Enhancing the Patient Experience with Follow-Up Diabetes Care while Increasing Efficiencies Using Quality Improvement Methods MARGARET DE MELO, PHILLIP SEGAL, ELAINE WYLIE, ANN MURPHY Toronto, ON Background: The rapid rise in the prevalence of diabetes and its ensuing healthcare costs has galvanized the need to pursue quality improvement strategies that improve efficiency. Objective: To improve efficiency and enhance patient experience in follow-up diabetes care. Design and Methods: Quasi-experimental mixed method was used with concurrent, non-randomized controls from a sister site within 2 tertiary academic endocrinology clinics. Direct observation and rapid improvement cycles were used to study and improve workflow and teamwork of a 3 monthly shared medical appointment (SMA) for follow-up adult patients with diabetes on insulin therapy, facilitated by a nurse, dietitian, endocrinologist and a patient volunteer. Quantitative and qualitative data on patient experience, time spent per patient per month, care plans and staff satisfaction were analyzed. Results: Preliminary results reveal psychological safety and shared internal conflicts as themes of enhanced patient SMA experience, which suggest increased staff satisfaction and integrated care plans of all patients, and circa 75%, 64% and 33% efficency gains per patient for follow-up diabetes care for nurse, dietitian and endocrinologist, respectively, compared to usual 1-1 care. Limitations: Results are not generalizable as a convenient sample of patients were offered the intervention. Despite internal validation and corroboration of results, potential biases exist. Run charts could not be objectively analyzed for evidence of non-random signals of improvement due to insufficient data points. Conclusions: An SMA for the provision of follow-up care is a potentially efficient alternative to 1-1 care and can enhance the patient experience. 80 Dietetic Referrals in Various Primary Healthcare Settings: A Literature Review STÉPHANIE ABOUEID*, IVY LYNN BOURGEAULT*, ISABELLE GIROUX* Ottawa, ON Obesity is multifactorial and contributes to many chronic diseases, such as type 2 diabetes. Individualized nutrition counselling by a dietitian has been shown to be effective in aiding patients with weight loss and management. Dietitian services are not publicly funded but are offered free of charge in team-based clinics, with a referral from a family physician (FP) or nurse practitioner (NP). The objective is to evaluate the use of dietetic referrals in different types of primary healthcare settings. Databases include Scopus, Cochrane, EMBASE, Science Direct and PubMed. The search retrieved 310 citations. Inclusion criteria: 1) primary care settings, 2) dietetic referrals, 3) adult patients, 4) article published from 2000 onwards and 5) quality. This resulted in 20 articles to be included in this review. Irrespective of the type of primary healthcare setting, there seems to be suboptimal use of dietetic referrals. However, referrals in team-based clinics are more likely due to having a dietitian in proximity, which promotes relationship building and interprofessional collaboration. Similarly, referrals are more used in rural clinics where primary care providers have less support from members of their own profession compared with urban areas. This factor and the