client behavioral goal setting: outcomes reviewed using cqi process
DESCRIPTION
Client Behavioral Goal Setting: Outcomes Reviewed Using CQI Process. -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. - PowerPoint PPT PresentationTRANSCRIPT
-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!