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Client Behavioral Goal Setting: Outcomes Reviewed Using CQI Process

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.

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Client Behavioral Goal Setting: Outcomes Reviewed Using CQI Process

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  1. 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

  2. Overview of Discussion • Review Documentation of Collaborative Goal Setting- Identify Patterns, Trends • Assess the Current Goal setting and outcome Measurement Practice • Identify Improvement Opportunities thru CQI

  3. “Opportunity Knocks” • Hypothesis • Process vs Outcome

  4. Instructions/ preparation • 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

  5. Discrepancies- words- Semantics • 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

  6. 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. Review of Process

  7. AADE 7 Self-Care Behaviors • Being Active • Healthy Eating • Taking Medication • Monitoring • Problem Solving • Reducing Risks • Healthy Coping

  8. 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 Goal Setting

  9. Comparison • # patients- 457 • # goals- 1006 • % LTF- 23 • # patients- 417 • # goals- 775 (1034) • % LTF- 22 2009 (2008) 2010 (2009)

  10. Analyze • Data Collection – audits part 1 and 2 • Goal Setting categories • By site, using the Handout 2009 Site Specific Achievement Data form.

  11. Breakdown by Goal Type Healthy Coping Problem Solving Healthy Eating 35% Physical Activity 21% Monitoring 20% Risk Reduction 11% Taking Medication 7% Problem Solving 5% Healthy Coping 2% Risk Reduction Taking Medication Physical Activity Monitoring Eating Healthy

  12. Breakdown by Achievement Level Always 35% Usually 30% Sometimes 22% Rarely 8% Never 5%

  13. AADE 7tm Compare 2008 to 2009 *********************** Big 3 67% Risk Reduction 1.3% • 76% (increase)  • 11% (increase)  *******************

  14. Educator/ Reviewer Comparison • Healthy Coping 3 • Healthy Eating 21 • Monitoring 18 • Phys Activity 19 • Prob Solving 5 • Risk Reduction 19 • Take Meds 7 • All92 3 100% 2 10 3 17 3 16 2 40 4 21 2 29 1921

  15. Educator Reviewer/ Behavioral • Healthy Coping 3 • Healthy Eating 21 • Monitoring 18 • Phys Activitiy 19 • Prob Solving 5 • Risk Reduction 19 • Take Meds 7 • All Combined 92 3 100 20 95 16 89 15 79 5 100 19 19 5 71 83 90 Goal # Category # no % no

  16. Learn from the mistakes of others. You won’t live long enough to make them all yourself.

  17. Ah ha!! • 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”

  18. {sigh}

  19. Example goal by topic 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

  20. Cont. PS- “Identify Potential problems” RR- “Follow MP, check 1x daily, check feet daily” Med- “med with meals as physician ordered”

  21. Next…………… • Develop a Plan • Implement the Plan

  22. Using CQI to Improve Client Goal Setting…. Critical Thinking

  23. Identify the Problem/Opportunity Collect the Data Analyze the Data Identify Alternative Solutions Develop Implementation Plan Implement the Plan Evaluate the Actions Maintain the Improvement CQI : A Step by Step Guide for Quality Improvement in Diabetes Education . AADE (2008). CQI Process

  24. Summary • 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!

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