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Client Behavioral Goal Setting: Outcomes Reviewed Using CQI Process

This program focuses on reviewing and improving client behavioral goal setting through a Continuous Quality Improvement (CQI) process. Led by experienced professionals from the Joslin Diabetes Center, the session will cover the identification of patterns and trends, assessment of current practices, and opportunities for improvement. Participants will learn to implement effective goal-setting strategies using patient data, ensuring personalized, measurable goals. The aim is to foster better self-care behaviors among clients by refining the educational and documentation processes within diabetes management.

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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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