Program Coordinator Guide · PDF fileERP Program Coordinator Guide . ... The application of education Recognition for the diabetes self-management education program at

ProgramCoordinatorGuideNational Standards for Diabetes Self-Management Education and Support Compliance Guide

1Copyright © 2016 by American Diabetes Association All rights reserved. This document or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the American Diabetes Association.

ERP Program Coordinator Guide

The ERP Program Coordinator Guide was developed to take the guess work out of ensuring your

program is compliant with the 10 National Standards for Diabetes Self-Management Education

and Support. The guide has examples and templates in each of the 10 standard sections that you may use but are not required to use. Your program will also be audit ready at all times if the guide is current per the Annual Requirement Tracker.

Instructions for Guide Use

Print ERP Program Coordinator Guide

Insert pages in a 3 ring binder

Replace Insert tab # pages with tabbed pages

Replace the front certificate sample with your DSME program certificate

Replace the letter of support sample with your DSME programs letter of support

Review the 3 green pages in the front demonstrating how to complete the 4 YearRceognition Cycle for your program on page 7.

Complete the blank Recognition 4 Year Cycle page with your program dates

Use the Recognition 4 Year Cycle page to define your Recognition Year 1,2, 3, and 4

dates at the top of the Annual Requirement Tracker

Per the Annual Requirement Tracker insert the designated documents and indicate this is

complete on the tracker

Three months prior to your program anniversary date send yourself an outlook calendar

reminder to review the Annual Requirement Tracker. This will guide you as to what has

not been completed yet for the year and allow you time to complete these requirements


R'fJFICATE OF RECOGNJ� C £ The AITll ell' iijc&n D ii& 1b e ties Assoc ii& ti({])! O I\!

A§ MEETITNG THE NATITONAL STANDARD§ FOR DITAIBETE§

§ELF-MANAGEMENT EDUCATITON

AWARDED FOR THE PERITOD OF

AAmerican Diabetes

® Association® Mmgaret Powers, PhD, RD, CDh' President, !- lea/th Care & Educaliou

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ID# 000000

rcecc(())gnizce§ lthce ceJuccaf iCO)n §cerviccce CO)f

Replace with a copy of your DSME Program Certificate


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RVentura

Highlight

ABC Diabetes Program

REPLACE WITH YOUR APPLICATION SUPPORT LETTER

SAMPLE LETTER – EVIDENCE OF ADMINISTRATIVE SUPPORT OF THE DSME PROGRAM

Note: If evidence of administrative support is in letter form, it must be on company letterhead.

Date

American Diabetes Association Education Recognition Program 2451Crystal Drive, Suite 800Arlington, VA 22202

Dear Sir or Madam:

The application of education Recognition for the diabetes self-management education program at (insert name of sponsoring organization) was (or will be) submitted on or about (insert date).

(Insert name of sponsoring organization) supports the efforts of (insert name of Program).

Sincerely, Name of Administrative Overseer Title

4Copyright © 2016 by American Diabetes Association All rights reserved.This document or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the American Diabetes Association.




Recognition 4 Year Cycle

__________ __________ to __________ __________ Month * Year ** 4 years later Month* Year

(per your program certificate)

Application Reporting Period

_________ __________ to __________ __________ Month Year Month Year

Recognition Year 1

_________ __________ to __________ __________ Month * Year ** Month* Year

Recognition Year 2

_________ __________ to __________ __________ Month* Year Month* Year

Recognition Year 3


Recognition Year 4 – *Renewal Application Year


• The renewal application can be initiated in the ERP portal up to 6 months prior to the program’sRecognition expiring

• It is recommended that renewal applications be submitted at least 60 days prior to theprogram’s Recognition expiring

o 30 days for ERP to processeso 30 days for program to notify their Medicare MAC with new certificate

Note all Required Recognition Documents should be maintained for 5 years to ensure the program is audit ready.


American Diabetes Association Diabetes Self-Management Education Recognition Program

Annual Requirement Tracker Requirement

Most Recent

Application Reporting

Period

Recognition Year 1

Recognition Year 2

Recognition Year 3

Recognition Year 4 Comments

Enter Dates for Recognition Years To To To To To

Use the Recognition 4 Year Cycle page to determine the dates.

Standard 1

Organization chart is current and in binder

Mission statement is in binder

Program goals’ achievement reviewed and upcoming year’s goals set and in binder

Standard 2 Advisory group activity complete and documentation is in binder

Standard 3

Population served and program assessment


is complete and in binder

Standard 4 PC job description and/or evaluation tool reflects duties and responsibilities of a PC is in binder

PC-Program Coordinator

Documentation reflecting PC’s credentials are current in binder Copy of PC’s current CDE or BC-ADM or 15 hrs. of CEU certificates in binder

# # # CEUs must be earned within past 12 months of application submission

Standard 5 Documentation reflecting all Professional Educators’ credentials are current in Binder

RDs must have copy of CDR verification or copy of CDR card

Copy of all Professional Educators’ current CDE or BC-ADM or 15 hrs. of CEU certificates in binder Copy of Single Discipline Program Out of Scope of Practice Policy in Binder

Required if program has professional educator/s of one discipline

Para-Professional educator proof of previous training or experience is in binder Para-Professional proof of 15 hrs. of annual training is in binder Para-Professional proof of competency in the areas she/he teaches is in binder Standard 6 DSME Curriculum in use Name:___________ ____________________________________ Documentation reflecting the DSME curriculum’s annual review or/and revision is in the binder Standard 7, 8, 9 Per the Multi-Site Chart Audit Guide in the * * * * *Review and update chart numbers


far right column, maintain list of charts per multi-site reflecting the Completed Initial Comprehensive DSMES cycle. The charts should include each step, A-J of the initial cycle which can be viewed at: www.diabetes.org/dsmescycle

Use Chart List (pg. 46-47) and Chart Review Form (pg. 48) as you review charts throughout the year

Multi-Site Chart Audit Guide 1 - 2 multi-sites = 5 charts/multi-site 3- 4 multi-sites = 3 charts/multi-site 5 or > multi-sites = 2 charts/multi-site

Standard 10 Documentation reflecting the program aggregations of at least one behavioral goal in binder Documentation reflecting the program aggregation of at least one other participant outcome in binder CQI project based on program aggregated outcome of a behavioral goal or one other participant outcome in binder

Once the above items are completed for the Recognition Year, the PC can attest to the program meeting the National Standards for DSME on the ASR Annual Status Report (ASR) Completed in ERP Portal up to 30 days prior to program’s anniversary month of

No ASR required during

application year

No ASR required during

application year

The ASR is available in the ERP portal 30 days before the program’s anniversary date

Note all Required Recognition Documents should be maintained for 5 years to ensure the program is audit ready.


http://www.diabetes.org/dsmescycle

Insert Tab 1


Date: Site/Location:

Auditors: American Diabetes Association’s Education Recognition Program

Review Criteria and Indicators: 9th Edition Data Period (Reporting Period): Current Operations:

2013 / 6

Standard #1: Internal Structure

The provider(s) of DSME will document their organizational structure, mission statement, and goals. For those providers working within a larger organization, that organization will recognize and support quality DSME as an integral component of diabetes care.

Review Criteria Indicators Yes No N/A

A. The DSME program will havedocumentation that addresses itsorganizational structure, missionand goals and its relationship tothe larger, sponsoringorganization.

1. There is evidence of the program’s:a. organizational structureb. mission statementc. goals

2. There is evidence of the largerorganization’s support andcommitment to the DSME program.

(e.g. Letter of support, participation ofsenior administrative personnel in theadvisory process or onsite audit)

Standard met? Yes No

Findings / Notes:


Board of Directors

CEO

Organizational Chart

Administrator CNO

Ancillary Manager Facility Manager Inpatient Clinical

Manager

Outpatient Education Manager

Cardiac Rehab Dialysis Center DSME Coumadin clinic

DSME Program Coordinator

RN RD Pharm D

Community Health Worker Diet Tech

Replace with your organization chart that includes your DSME program


Sample Mission Statement

The mission of the diabetes team at this facility is to provide quality comprehensive diabetes self-management education. We believe that education is the key to empowering the person with diabetes to better manage his or her disease and avoid the complications of diabetes and achieve an optimum health status.


ABC’S Diabetes Program Goals

Goals reviewed for last year and new goals for 20 __are:

1. To transfer diabetes education documentation from paper to the new ABC organizationwide EMR and continue to capture the educational outcomes and the entire DSMEeducation process from referral (when insurance requires), assessments, educationplan, education intervention, behavioral goals set, DSMS plan, follow up for goal andother participant outcome and communication with other health care team members(e.g. Referring providers, social services agency staff, school nurse, etc.) regarding DSMSplan and any relevant information.

2. Hire, train and document annually competency of 2 new Paraprofessional educators toteach the following 3 of 9 topic areas (DM disease process, SMBG, Exercise). Assign eachof the 2 Paraprofessional educators a supervising Professional educator.

3. Revamp ABC’s Diabetes QI project from MD satisfaction to a project baseon a regularly aggregated patient centered program outcome.

4. Contract out to the top 3 referring physician practices and to create multi sites at theirlocations. Dated: May 31, 20__

Tip #1: Dated within one year of application


Insert Tab 2





2013 / 6

Standard #2: External Input

The provider(s) of DSME will seek ongoing input from external stakeholders and experts in order to promote program quality.


A. An Advisory Group is in placeand is representative of diabetesstakeholders in the provider’sservice community.

1. There is evidence of a process for seekingexternal input and/or describing activitiesinvolving diverse stakeholders providinginput or feedback for program improvementor development.

(e.g. of documentation: meeting minutes, policy)

(e.g. of external stakeholders – person with diabetes, person affected by diabetes, community group representative(s), other healthcare professionals outside of the diabetes program)

2. Single discipline programs must also have ahealthcare professional(s) of a differentdiscipline-other than that of the singlediscipline program.

B. Activities of the AdvisoryGroup, reflecting its input inenhancing the quality of theDSME/S service are documentedat least annually

1. There is documented evidence of at leastannual input from external stakeholders ofthe program.

(e.g. meeting minutes, ballots, surveys,documented phone consults, emails)


Findings / Notes:


Advisory Group Activity

Standard #2: An advisory group activity is required each within 12 months or an original application and annually per the program’s anniversary date noted on the ADA Recognition

Certificate

Activity Date: ______________20________ Activity Type (Select One):

Documented in person meeting Documented emails Documented phone conversations

Ballot DSME program survey

Advisory Members Name Participated Did not participate

Program Coordinator

External Stakeholders

Healthcare Professional of another discipline (required if program is a single discipline program)

The DSME program input for improvement or development gained from this activity:


Meeting Minutes:


Insert Tab 3





2013 / 6

Standard #3: Access The provider(s) of DSME will determine who to serve, how best to deliver diabetes education to that population, and what resources can provide ongoing support for that population.


A. The DSME program willidentify who to serve in itscommunity, and assess factorsthat may prevent the populationserved from accessing thediabetes education program andsupport services.

1. Documentation exists that reflects anannual assessment of:

a. The population served(e. g. demographics, culturalinfluences, access to healthcareservices, barriers to education)

b. Program resources relative to thepopulation served(e. g. physical space, staffing,scheduling , equipment, interpreterservices, multi-language educationmaterials, low literacy materials, largeprint education materials)

c. A plan to address any identified needs(e. g. identification of resources foradditional services, plan for options forclass times )


Findings / Notes:


Population Served and Program Assessment

The population -__________________serves (DSME program name)

Population Served and Program Assessment – Standard 3 If the population you plan to serve includes specific counties, cities, states etc. you may find information on your local or state health department website or the CDC website at: http://apps.nccd.cdc.gov/DDTSTRS/default.aspx. You can also find information by searching: (Your State) diabetes trends or database.

Population Your

Program Plans to

Serve

Population

Currently

Serving

Key: These % can be estimates rather than actual. 0 = None 1= ~25% or less 2 = ~ 50% or less 3 =~>50%

Race of Population American Indian or Alaskan Native 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Asian/Chinese/Japanese/Korean/Pacific Islander 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Black/African American 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Hispanic/Chicano/Cuban/Mexican/Puerto Rican/Latino 0 - 1 - 2 - 3 0 - 1 - 2 - 3

White/Caucasian 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Middle Eastern 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Age of Population

19 years or less 0 - 1 - 2 - 3 0 - 1 - 2 - 3

19-44 years 0 - 1 - 2 - 3 0 - 1 - 2 - 3

45 – 65 years 0 - 1 - 2 - 3 0 - 1 - 2 - 3

>65 years 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Type of Diabetes of Population

Pre Diabetes Age up to 19 years 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Pre Diabetes > 19 yrs 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Type 1 Diabetes 0-18 yrs 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Type 1 Diabetes >18 yrs 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Type 2 Diabetes 0 – 18 yrs 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Type 2 Diabetes > 18 yrs 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Pregnancy with Pre existing DM 0 - 1 - 2 - 3 0 - 1 - 2 - 3

GDM 0 - 1 - 2 - 3 0 - 1 - 2 - 3

Unique Needs of Population

Hearing Impaired (Requiring Sign language) Yes No Yes No

Visual Impaired (Requiring Print augmentation) Yes No Yes No

Language Barrier (Requiring Interpreters) Yes No Yes No

Low Literacy Population Yes No Yes No

Transportation Opportunities Yes No Yes No

Physical Facility Needs (class room space, ramps, elevators, etc…)

Yes No Yes No

Technical Savvy Pts Yes No Yes No

Insured Yes No Yes No

Uninsured Yes No Yes No

Diabetes Treatments

Oral Anti-Diabetes Medication Yes No Yes No

Insulin Yes No Yes No

Concentrated Insulin – U-500, U-300 Yes No Yes No

Inhaled Insulin Yes No Yes No

Injectable Anti-Diabetes Medications other than Insulin Yes No Yes No

Insulin Pumps Yes No Yes No

CGMS Yes No Yes No


http://apps.nccd.cdc.gov/DDTSTRS/default.aspx

Based on the program’s population served and plans to serve data, now assess the program’s resources and how they meet the population’s DSME identified needs

Physical Space Program resources and assets that are addressing or

meeting the needsPlan to address identified needs

Staffing Program resources and assets that are addressing

or meeting the needs Plan to address identified needs

Scheduling Program resources and assets that are addressing


Equipment Program resources and assets that are addressing


Interpreter Services Program resources and assets that are addressing


Multi-Language Education Materials

Program resources and assets that are addressing or meeting the needs Plan to address identified needs

Low Literacy Education Materials


Large Print Education Materials


Electronic Education Materials

Program resources and assets that are addressing or meeting the needs

Plan to address identified needs

Electronic and Web based DM Management Resources

Program resources and assets that are addressing or meeting the needs

Plan to address identified needs

Curriculum Program resources and assets that are addressing



Insert Tab 4





2013 / 6

Standard #4: Program coordination

A coordinator will be designated to oversee the DSME program. The coordinator will have oversight responsibility for the planning, implementation, and evaluation of education services.


A. The DSME program yhas a designatedcoordinator whooversees the planning,implementation andevaluation of theprogram at all sites.

1. There is documentation of oneprogram coordinator as evidenced bya job description, performanceappraisal tool, or other.

B. The coordinator isacademically orexperientially preparedin areas of chronicdisease care, patienteducation and/orprogram management.

1. Curriculum Vitae, resume or jobdescription of the coordinator reflectsappropriate qualifications.

2. Coordinator is CDE or BC-ADM, orannually accrues 15 hours of CEcredits based on programanniversary date.(e. g. of CE topics: chronic diseasecare, patient education and programmanagement.)


Findings / Notes:


Program Coordinator

Job/Position Description Template 1. The title of this position should be one that indicates leadership, such as coordinator, manager

or director.2. The following must be included in the description of the tasks:

• Oversight of the planning, implementation and evaluation of the DSME program (at allsites, if there is more than one site in the program)

3. The following must be included in the qualifications for this position• Academic and/or experiential preparation in program management• Academic and/or experiential preparation in the care of people with a chronic disease.• Education Requirements• License/Registrations/Certifications as applicable

EXAMPLE JOB TITLE: Diabetes Program Coordinator DEPARTMENT: Outpatient clinic REPORTS TO: VP of Nursing

JOB SUMMARY The Diabetes Program Coordinator is responsible for overseeing the day-to day operations of the DSME program at all sites. Ensures that the National Standards(NSDSME) are met and maintained at all times.

DUTIES AND RESPONSIBILITIES

1. Oversees the planning, implementation and evaluation of the DSME program.2. Arranges and coordinates the activities of the Advisory Group.3. Liaises between the staff, the Advisory Group, other departments and administration.4. Monitors and facilitates maintenance of staff qualification (CE credits, licensures, and

registrations)5. Responsible for maintaining ADA Recognition and participating in the evaluation of the

program’s effectiveness.QUALIFACTIONS

1. Required/expected academic preparation (e.g. minimum of Bachelor’s degree required,Master’s preferred, etc.)

2. Required licenses, registrations, certifications for area of specialty3. Required experience in clinical practice4. Required experience in program management


Resume Template

Personal: Name Address Telephone- daytime Fax # Email Address

Education: Month/year: Academic degree or professional degree and professional credential From which college/university Major field of study (Repeat this section for each academic degree and professional credential

Professional Registration: List all professional registration/licenses and or certifications

Include the state and number

Professional Experience: Month/Year to present: include place, address and your title

Brief summary of job duties/ responsibilities (Example: Diabetes Program Coordinator- Oversees day to day operations, including planning, implementing and evaluating of program)

Month/Year to Month/Year: begin with the most recent to the earliest Include the place, address, title Brief summary of job duties/responsibilities (Example: Director of clinical Nutrition Services- Responsible for developing policies and procedures related to nutrition assessment, treatment and education of patients, staff supervision.)

Membership: Include all professional membership and academic memberships

Personal: Include any personal information that will show your professional, leadership, and or any quality that describes you. Include awards, internships, leadership roles that you have had in the past

References: Upon request


Insert Tab 5





2013 / 6

Standard #5: Instructional staff One or more instructors will provide DSME and, when applicable, DSMS. At least one of the instructors responsible for designing and planning DSME and DSMS will be a registered nurse, registered dietitian, or pharmacist with training and experience pertinent to DSME, or another professional with certification in diabetes care and education, such as a CDE or BC-ADM. Other health workers can contribute to DSME and provide DSMS with appropriate training in diabetes and with supervision and support.


A. The DSMEinstructor(s) mustinclude at least one RNOR one RD OR onepharmacist OR onecertified diabetesprofessional.

1. At least one RN or one RD or onepharmacist or one certifieddiabetes professional (e.g. CDE orBC-ADM) is involved as an instructorin the education of programparticipant(s).

B. DSME instructor(s)must be qualified andprovide diabeteseducation within eachdiscipline’s scope ofpractice.

1. Professional Instructor(s) must havevalid, discipline-specific licensesand/or registrations.

2. Paraprofessional instructors musthave supervision by a clinical orhealthcare professional instructor(identified in A.1. above) Supervisioncan be demonstrated by jobdescription, performance appraisaltool or other.

3. Paraprofessional staff mustdemonstrate training orcompetencies in specific areasdetermined by the program. (e.g. in- service in educational methods,diabetes, other; CHW certification;Health Education credential)

4. All instructors must demonstrateongoing training in DSME/S topics.

a. non-certified diabeteseducators must accrue 15hours CE annually based onprogram anniversary date

b. paraprofessional instructorsmust accrue 15 hours of in- services annually based onprogram anniversary date





2013 / 6

C. A mechanism must bein place to meet theneeds of participants ifthey cannot be metwithin the scope ofpractice of theinstructor(s)

1. Guidelines must be in place fordetermining procedure for meetingparticipants’ educational needs whenthey are outside the scope of practiceof instructor(s).(single discipline or paraprofessionalstaff involved in instruction)

Standard Met? Yes No

Findings / Notes:


Example

Single Discipline Program

Out of Scope of Practice Policy

Purpose: To provide guidance when a patient’s education needs are outside of the scope of practice of the single discipline diabetes self-management education program.

Para professional credentials do not influence the program's status as single or multi-discipline.

Procedure: When a patient has a DSME need that is outside of the scope of practice of the single discipline program the following will occur:

• The patient will be provided a list of providers that can provide the education needed• The referring provider will be notified of the DSME topics not provided because they

were outside of the scope of practice of the single discipline program.• The communication to the physician will be documented in the patient’s medical record.


CEU Guidelines

Annual Professional Educators’ CEU and Para-Professional Educator Training Requirements

• Professional Educators that are not a CDE or BC-ADM require documentation reflecting15 hours of CEUs annually per these guidelines

• Para-professional educators require documentation reflecting 15 hours of training annuallyper these guidelines

• The CEUs and training requiredo At the time of an applicationo The past 12 months prior to the application submissiono During 4 year Recognition Cycle

The annual requirements are based on the program’s Recognition anniversarymonth

CEU Providers and Topics

• Professional educator CEUs must be diabetes related per the NCBDE exam content areaswhich can be found on page 22 – 24 of thelink: http://www.ncbde.org/assets/1/7/Handbook_Current.pdf

• The CEU must be provided by a NCBDE approved CEU organization foundat: http://www.ncbde.org/assets/1/7/Handbook_Current.pdf

CEU Topics • Diabetes Specific

• Diabetes Related: nutrition, exercise, retinopathy, nephropathy, neuropathy, cardiovasculardisease, stroke, lipids, obesity, metabolic syndrome, etc.

• Psychosocial: psychological, behavioral or social content related to diabetes, self-managementor chronic disease.

• Education: knowledge assessment, learning principles, education, training or instructionalmethods

• Program Management: operations of the DSME, including business operations, performanceimprovement, case and disease management.

If the program title does not fit one of the above: Include a copy of the official program brochure with objectives or a copy of the official course outline.


http://www.ncbde.org/assets/1/7/Handbook_Current.pdf





CEU Guidelines

• CEU Certificates and Logso The CEU certificate must display the following

Educator’s name Title of the CEU program Date/s the CEU hours were earned Number of CE hours Name of the NCBDE approved credentialing body

o RD or CDE logs are not accepted because they are populated by the RDo CPE logs are accepted

CPE (Accreditation Council for Pharmacy Education) will no longer provideCEU certificates. CPE populates the logs with the CEU data

• CEUs - Not acceptedo Exhibit hall hourso BLS and ACLS courseso Poster Sessions: unless accompanied by objectives provided during the sessiono Academic credits (college credits) unless the college or university:

is approved by an NCBDE recognition organization the college/university converts the credits to CEU hours and provides

verification of conversion on official letterhead


DSME Program Educator and Program Coordinator Credentials and CEU Tracker

All educator and program coordinator credentials and CEUs (if applicable) must be kept on file from the programs most recent new or renewal application until the program re-applies for a new Recognition cycle of 4 years.

Program #: Program Anniversary Date: Site Name:

12 months prior to most recent program new or renewal application Program Certificate Year 1 Program Certificate Year 2 Program Certificate Year 3 Program Certificate Year 4

enter months - example 5/2014-5/2015 enter months - example 5/2014-5/2015 enter months - example 5/2014-5/2015 enter months - example 5/2014-5/2015 enter months - example 5/2014-5/2015

Name

DSME Program Hire

Date

DSME Program

Term Date

Appropriate licensure or CDR

for RDs CDE or BC-ADM or

15 hrs of CEUs*


for RDs CDE or BC-ADM

or 15 hrs of CEUs*


for RDs

CDE or BC-ADM or 15 hrs of

CEUs*


for RDs


CEUs*


for RDs


CEUs* Program Coordinator

Professional Educators (If an educator works at multiple sites indicate which site binder the licenses and credentials will be kept on file)

Paraprofessional Educations

Documentation reflecting competent in the DSME

areas she/he teaches

15 hrs of training annually Documentation reflecting competent in the DSME

areas she/he teaches

15 hrs of training annually

Documentation reflecting competent in the DSME areas she/he

teaches



teaches



teaches


Temp Employees

Appropriate licensure or CDR for RDs

Has 4 months from hire to date to obtain 15 CEUs if

not CDE or BC-ADM



not CDE or BC-ADM


Has 4 months from hire to date to obtain 15

CEUs if not CDE or BC- ADM



not CDE or BC-ADM


Has 4 months from hire to date to obtain 15

CEUs if not CDE or BC- ADM

Resource Staff are professionals that assist with the program and provide less than 10% of the program's education

Admin Staff that do not provide eudcation should not be included on the program application. This staff can do data entry but does not provide education

Referring providers should not be on the DSME program application unless they are providing 10% or more of the DSME education


Para Professional (enter name)___________________________Annual Training Para-professionals require 15 hours of training each program recognition year or the previous 12 months prior

to a program new or renewal application

Para-professionals require annual documentation reflecting they are competent in the areas of DSME theyteach

Program must have documentation reflecting para-professionals experience prior to joining the DSME program

Para-professionals cannot do the participant evaluations or set the education plans

Para-professionals should be trained to defer questions outside of their scope or clinical questions back to aprofessional educator

The professional educator does not have to present for the para-professional to teach within their scope ofpractice per their annual documented training

Para-professional instructors do not determine if a program is a single discipline or multi-discipline program

Program Recognition Year: ____________________ to __________________________

Date Training Topic, Method, and Provider Hours DSME Category C= Denotes

Competent in a Category

01.01.2017 Example

Sweet BG Meter Rep provided training on their meters that our program participants use. Training included meter set up (time, date, participants BG parameters), using the meters, and uploading the meters and meter reports. The Sweet BG Meters reviewed were: list meters

2.5 hrs. 5 C

Competency noted

02.14.2017 Class 1 of 4 for Plate Method teaching 1 hr. 2

Para-Professional DSME Training Category Key

1 – Diabetes Disease Process and Treatment Options 2 – Incorporating Nutrition Management into lifestyle 3 – Incorporating Physical Activity into lifestyle 4 – Using Medication Safely for maximum efficacy 5 – Monitoring Glucose and using the results for decisions

6 – Preventing, detecting, treating acute complications 7 - Preventing, detecting, treating chronic complications 8 – Developing strategies to address psychosocial issues 9 – Developing strategies to promote heath and behavioral change

Copyright © 2016 by American Diabetes Association All rights reserved.

This document or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the American Diabetes Association. 36

DSME Staff Type

• Professional instructional staff• Credentials current during 4 year recognition period• *CEU’s if not a CDE or BC-ADM required• Include on applications•

• Para-professional instructional staff• Proof of training/experience prior to joining DSME program• Proof of 15 hrs of training per recognition year• Proof of training in areas of DSME she/he teaches each recognition year• Include on applications

*CEUs and credentials must be kept from the ones submitted with the most recent programapplication and during the 4 year Recognition Period*Recognition year is the month of recognition one year to the month of recognition the nextyear

• Temporary instructional staff• Two types of Temporary Instructors

1. May be a professional instructor that fills in while permanentinstructor is on vacation

2. A permanent professional instructor can be a temporary instructor forthe first 4 months after hire (not para-professional) to allow time toobtain CEUs

• Do not include on application• Credentials have to be current• Keep proof of hire date in case of an audit

• Resource instructor• Professional instructor• Credentials and CEUs do not have to be kept by program• Do not include on application• Must teach less than 10% of the program

• Administrative staff• Does not provide education• No credentials or ceus required• Do not include on application

• Referring providers• Are not instructional staff• Do not include on application• Credentials and CEUs do not have to be kept in DSME files

s/`1111.ERP Program Coordinator Guide/Std 5. Staff Types Amended 8/9/2016


Insert Tab 6





2013 / 6

Standard #6: Curriculum

A written curriculum reflecting current evidence and practice guidelines, with criteria for evaluating outcomes, will serve as the framework for the provision of DSME. The needs of the individual participant will determine which parts of the curriculum will be provided to that individual.


A. A written curriculum, withlearning objectives andcriteria for specifyingmethods of delivery andevaluating successfullearning outcomes, is theframework for the DSME.

1. Validate that the education process is guidedby a reference curriculum with learningobjectives, methods of delivery and criteria forevaluating learning for the populations served(including pre-diabetes, diabetes type 1, type 2,GDM or pregnancy complicated by diabetes) inthe following 9 content areas:

I. Describing the diabetes disease process andtreatment options (includes pre-diabetes)

II. Incorporating nutritional management intolifestyle

III. Incorporating physical activity into lifestyleIV. Using medication(s) safely and for maximum

therapeutic effectivenessV. Monitoring blood glucose and other

parameters and interpreting and using the results for self-management decision making

VI. Preventing, detecting, and treating acute complications

VII. Preventing, detecting, and treating chronic complications

VIII. Developing personal strategies to address psychosocial issues and concerns

IX. Developing personal strategies to promote health and behavior change

2. There are supporting materials relevant to thepopulation served.

B. There is periodic review and

revisions of the curriculumand/or course materials toreflect current evidence.

1. There is evidence of regular review andrevisions as needed (at least annually), of thecurriculum and/or course materials by DSMEinstructor(s) and/or advisory group.

C. There is evidence that theteaching approach isinteractive, patient-centeredand incorporates problemsolving.

1. There is documentation in the curriculum(methods) or other supporting documentwhich demonstrates that instruction istailored/individualized and involvesinteraction.


Findings / Notes:


Curriculum Review Tracker Curriculum Used: _________________________________________________________

Requirement Most Recent Application

Reporting Period

Recognition Year 1

Recognition Year 2

Recognition Year 3

Recognition Year 4 Comments

Enter Dates for Recognition Years To To To To To

Use the Recognition 4 Year Cycle page to determine the dates.

Curriculum Review Date/s

List Reviewers

No Changes Required per Review (check appropriate box if applicable) List Curriculum Updates (if applicable)


A Written Complete Curriculum

The application criteria requires a program to have a written complete curriculum based on the 9 core content areas listed in Standard 6 of the 2012 National Standards for Diabetes Self- Management Education and Support.

Each content area includes the following four components for Pre-Diabetes, Type 1, Type 2, Gestational Diabetes and Pregnancy Complicated by Diabetes:

• Learning objectives: What the patient will be able to do after completing the section.• Method of delivery that is tailored/individualized and involves interaction.• Topic Content• Methods of evaluating successful learning outcomes.

Education documentation plan: There is written documentation of the education process.

Example: Content Area: Incorporating Physical Activity Into Lifestyle**

Purpose: To provide information regarding the effects of physical activity on blood glucose and the possible dietary changes necessary with changes in activity. The opportunity to create an individual physical activity plan will be provided.

Learning Objectives: At the end of this session, the participant will be able to: 1. List three benefits of physical activity2. Describe the effects of activity on blood glucose3. State signs and symptoms of hypoglycemia4. Describe how to make adjustments in food intake or insulin dose to account for

activity5. Develop a personal activity plan

Methods of Instruction: • Discussion• Exercise video• Q & A


Content: 1. Benefits of regular exercise2. Effects on blood glucose3. Choosing/creating an exercise program4. Aerobic vs. anaerobic exercise5. Hypoglycemia and exercise6. Food/insulin adjustments for exercise7. Tips for staying with your program

Methods of Evaluation: • Responses to questions• Questions asked by participants• Application of knowledge evidenced by review of exercise plan (if selected goal)

Documentation: • Date, content area, initials of instructor and post-education evaluation will be documented

on the education record

Curriculum Note: • A DSME curriculum that meets Standard 6’s criteria can be developed by the DSME program

or the program may choose to use an existing curriculum. The below is a list of some of theexisting curriculums that meet standard 6’s criteria.

o American Diabetes Association Life With Diabetes Recognized DSME program can receive a 40% discount Life with Diabetes www.diabetes.org Right Menu Bar - select ERP 40% discount on publications and books

o International Diabetes Center Basic Diabetes Curriculumo Healthy Interactions Conversation Mapso AADE 7 Curriculum


Insert Tab 7





2013 / 6

Standard #7: Individualization

The diabetes self-management, education, and support needs of each participant will be assessed by one or more instructors. The participant and instructor(s) will then together develop an individualized education and support plan focused on behavior change.


A. Participants receive acomprehensiveassessment, includingbaseline diabetes selfmanagement knowledgeand skills, and readinessfor behavior change.

1. An assessment of the participant isperformed in the following domains inpreparation for education:

a. clinical (diabetes and otherpertinent clinical history)

b. cognitive (knowledge of selfmanagement skills, functionalhealth literacy)

c. psychosocial (emotionalresponse to diabetes)

d. diabetes distress, supportsystems

e. behavioral (readiness forchange, lifestyle practices, selfcare behaviors)

Parts of the complete assessment may be deferred if applicable and the rationale for deferment documented.

B. Participants have aneducation plan based ontheir individualassessment.

1. There is evidence of an ongoingeducation planning and behavioralgoal-setting based on the assessedand/or re-assessed needs of theparticipant.

C. There is implementationof the education plan.

1. Education is provided based onparticipant need(s) and educationplan.

D. The education process isdocumented in thepermanent record.

1. Documentation in the participantchart includes evidence of theeducation process: referral fromprovider (if applicable), assessments,education plan and educationalinterventions.


Findings / Notes:


Referral if required by

pt's insurance Assessment of all 9 content

areas

Education Plan per pt's assessed needs

and concerns

Education Intervention

Education Learning

Outcomes

Behavioral Goal/s Set

Behavioral Goal/s Follow up

DSMS Plan Set & Communicated

See Step J

Outcomes Measured

Communication with other HCP regarding

education plan or education provided,

outcomes and the DSMS plan.

After the assessment each

item must be completed in no

specific order

The initial comprehensive DSME Cycle is complete when A-J can be identified.

For more details please see the Standard 7, 8 & 9

Complete Initial/Comprehensive DSMES Cycle

See Standard 7

The initial comprehensive DSME Chart is complete when A-J can be identified. For more details please see the Standard 7, 8 & 9 of the Review Criteria


Copyright © 2016 by American Diabetes Association All rights reserved. This document or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the American Diabetes Association.

___________________________________ Complete Charts (Enter Multi-Site Name)

Each month list a chart that reflects the DSME Cycle that was completed within the past 1 to 3 months. The number of charts you need per multisite is determined by the number of multi-sites your program has. The chart below indicates this number. Remember the primary program site is also a multisite.

# Multi Sites # Charts Reflecting the complete DSME Cycle Required from each Multisite

1– 2 Multi Sites 5 Charts per Multi Site per Period


5+ Multi Sites 2 Charts per Multi Site per Period


Year 1 Year 2 Year 3 Year 4 1 Chart per Multi Site each monthly

1. Print5 charts per multi-site from the reporting period

2.Label charts per the DSME cycle (A – J)

3.File in PC Guide binder

January

February

March

April

May

June

July

August

September

October

November

December

46

Copyright © 2016 by American Diabetes Association All rights reserved. This document or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the American Diabetes Association.

___________________________________ Complete Charts (Enter Multi-Site Name)

Each month list a chart that reflects the DSME Cycle that was completed within the past 1 to 3 months. The number of charts you need per multisite is determined by the number of multi-sites your program has. The chart below indicates this number. Remember the primary program site is also a multisite.

# Multi Sites # Charts Reflecting the complete DSME Cycle Required from each Multisite



5+ Multi Sites 2 Charts per Multi Site per Period


Year 1 Year 2 Year 3 Year 4 1 Chart per Multi Site each monthly

1. Print5 charts per multi-site from the reporting period

2.Label charts per the DSME cycle (A – J)

3.File in PC Guide binder

January

February

March

April

May

June

July

August

September

October

November

December

47

DSME/S Chart Review Form

Std DSME/S Chart Checklist

DSME

Cycle Example Page #

7

Provider referral if insurance requires one. Medicare requires a referral. A

Participant assessment:

Clinical: Health history B

Cognitive: Functional health literacy and numeracy B

Diabetes Distress and Support Systems B

Assessment of the 9 Topic Areas Ability to describe the Diabetes Disease Process and treatment options. B

B Ability to incorporate Nutritional management into lifestyle B

Ability to incorporate Physical Activity into lifestyle

Psychosocial and self care behaviors: (i.e., cultural influences, health beliefs, health behavior, lifestyle practices,support systems, barriers to learning, relevant socioeconomic factors, experience and behavior

B

Ability to use Medications safely (if applicable) B

Ability to Monitor blood glucose and other parameters; interpreting and using results

B

Ability to prevent, detect and treat Acute Complications. B

Ability to prevent detect and treat Chronic Complications B

Ability to develop personalize strategies to address Psychosocial Issues and concerns -Examples: Psychosocial and Self Care Behaviors: Emotional Response to Diabetes, Cultural Influences, HealthBeliefs, Health Behavior, Lifestyle Practices, Barriers to Learning, Relevant Socioeconomic Factors

B

Ability to develop personalize strategies to Promote Health and Behavioral Change

Example: goal setting, behavioral change strategies aimed at risk reduction such as preconception care, readiness to change

B

Education Plan based on patients concerns and assessed needs C

Summary of education intervention with date, content taught and instructor’s name

DateD

Education learning outcomes E

Patient selected behavioral goal set F

9 Patient selected behavioral goal follow up G

8 Patient selected Diabetes Self-Management Support (DSMS) plan selected and communicated to referring provider H

9 Other participant outcome/s measured I

8 Documentation reflecting communication with referring provider regarding education plan, or education provided

and outcomes J

9th Edition – revised 10/2016


Sample

Templates

Initial Self-Assessment

Diabetes Self- Management Education Record

Behavior and Other Participant Outcomes


PARTICIPANT SELF ASSESSMENT OF DIABETES MANAGEMENT

Name: Date:

Date of Birth: / / Age: Gender: F M

Ethnic Background: White/Caucasian Black/A-A Hispanic Native American Middle-eastern

What is your language preference: English Other

Address: Street City ST Zip

Phone: Home ( _)_ Work: ( ) Mobile: ( )

1. What type of diabetes do you have? Type 1 Type 2 Pre-diabetes GDM Don’t Know

2. Year/Age of Diabetes Diagnoses: /_ List relatives with diabetes:

3. Do you take diabetes medications? Y (check all that apply below) N Diabetes pills Insulin injections Byetta injections Symlin injections

Combination of pills and injections

About how often do you miss taking your medication as prescribed?

4. Do you have other health problems? Y N

Please list other medical conditions:

5. Do you take other medications? Y N Please list other medications:_

6. What is the last grade of school you have completed?

7. Are you currently employed? Y N What is your occupation?

8. Marital Status: Single Married Divorced Widowed How many people live in your household?

9. How are they related to you?

10. From whom do you get support for your diabetes? Family Co-workers Healthcare providers Support group No-one

11. Do you have a meal plan for diabetes? Y N If yes, please describe: About how often do you use this meal plan? Never Seldom Sometimes Usually Always

Do you read and use food labels as a dietary guide? Y N

Do you have any diet restrictions: Salt Fat Fluid None Other

Give a sample of your meals for a typical day:

Time: Breakfast:_

Time: Lunch:

Time: Dinner:

Time: Snack: Time: Snack:

12. Do you: do your own food shopping? Y N Cook your own meals? Y N How often do you eat out?

13. Do you drink alcohol? Y N Type: How many per day per week occasionally

21. Do you use tobacco: cigarette pipe cigar chewing none quit --how long ago

14. Do you exercise regularly? Y N Type: How Often: My exercise routine is: easy moderately intense very intense

15. Do you check your blood sugars? Y N Blood sugar range: to How often: Once a day 2 or more/day 1 or more/Week Occasionally

When: Before breakfast 2 hours after meals Before bedtime

What is your target blood sugar range?

16. In the last month, how often have you had a low blood sugar reaction: Never Once One or more times/week

What are your symptoms? How do you treat your low blood sugar?

17. Can you tell when your blood sugar is too high? Y N What do you do when your sugar is high?

18. Check any of the following tests/procedures you have had in the last 12 months:dilated eye exam urine test for protein foot exam--self --healthcare professional dental exam

blood pressure weight cholesterol HgA1c flu shot pneumonia shot


PARTICIPANT SELF ASSESSMENT OF DIABETES MANAGEMENT

19. In the last 12 months, have you: used emergency room services been admitted to a hospital

Was ER visit or hospital admission diabetes related? Y N

20. Do you have any of the following: eye problems kidney problems numbness/tingling/loss of feeling in

your feet dental problems high blood pressure high cholesterol sexual problems depression 22. Have you had previous instruction on how to take care of your diabetes? Y N How long ago:

22. In your own words, what is diabetes?

23. How do you learn best: Listening Reading Observing Doing

24. Do you have any difficulty with: hearing seeing reading speaking

Explain any checked:

27. Do you have any cultural or religious practices or beliefs that influence how you care for your diabetes?

Y N Please describe

25. Do you use computers: to email look for health and other information

26. Please state whether you agree, are neutral or disagree with the following statements:I feel good about my general health: agree neutral disagree

My diabetes interferes with other aspects of my life: agree neutral disagree

My level of stress is high: agree neutral disagree

I have some control over whether I get diabetes complications or not: agree neutral disagree

I struggle with making changes in my life to care for my diabetes: agree neutral disagree

27. How do you handle stress?

28. What concerns you most about your diabetes?

29. What is hardest for you in caring for your diabetes?

30. What are your thoughts or feelings about this issue (e.g., frustrated, angry, guilty)?

31. What are you most interested in learning from these diabetes education sessions?

32. Pregnancy and Fertility:

Are you: Pre-menopausal Menopausal Post-Menopausal N/A

Are you pregnant? Y --When are you expecting?

N --Are you planning on becoming pregnant?

Have you been pregnant before? Y N Do you have any children? Y --Ages: N

Are you aware of the impact of diabetes on pregnancy? Y N

Are you using birth control? Y --please specify N

*Please do not write below this line*

CLINICIAN ASSESSMENT SUMMARY:

Education Needs/Education Plan: Diabetes disease process Nutritional Management Physical Activity

Using Medications Monitoring Preventing Acute Complications Preventing Chronic Complications

Behavior Change Strategies Risk Reduction Strategies Psychosocial adjustment

Date: Clinician Signature:

1818


Participant Name: DOB: ____________________ Referring Provider: _________________________________

Assessment/Scale: 1= needs instruction 2= needs review 3= comprehends key points 4= demonstrates understanding/competency NC= not covered N/A= not applicable

Diabetes Self-Management Education Record

Topics Learning Objectives

Initial Initial Initial or Post Prgm

Initial or Post Prgm





Comments Pre Edu Asses

Edu outcome or Reass




Edu outcome or

Reass



Educator Initial: Date:

Diabetes disease process and Treatment process Define diabetes and identify own type of diabetes; list 3 options for treating diabetes

Incorporating nutritional management into lifestyle Describe effect of type, amount and timing of food on blood glucose; list 3 methods for planning meals

Incorporating physical activity into lifestyle State effect of exercise on blood glucose levels

Using Medications safely State effect of diabetes medicines on diabetes; name diabetes medication taking, action and side effects

Monitoring blood glucose, interpreting and using results Identify recommended blood glucose targets and personal targets

Prevention, detection, and treatment of acute complications List symptoms of hyper- and hypoglycemia; describe how to treat low blood sugar and actions for lowering high blood glucose levels Prevention, detection and treatment of chronic complications Define the natural course of diabetes and describe the relationship of blood glucose levels to long term complications of diabetes Developing strategies to address psychosocial issues Describe feelings about living with diabetes; identify support needed and support network Developing strategies to promote health/change behavior

Define the ABCs of diabetes; identify appropriate screenings, schedule and personal plan for screenings.

Comments: ___

Participant Selected DSMS Plan ___ ______ _______________

Participant Selected Behavioral Goal/s and Outcomes: _________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ Clinician Signature: ______________________________________ Clinician Signature: _________________________________________________


Instructions for Form Use:

This form can be used for initial comprehensive DSME and for post program DSME. The top two rows of the above table are used to indicate this.

Top Row: Indicate if the patient visit/session is initial comprehensive DSME or post program DSME

Second Row: Indicate if the column is being used to document education outcomes or re-assess the patient’s needs.



Patient name:

1. A personal health goal of mine is to:

In order to meet this goal, I will:

How many times/minutes per day? Per week?




Patient Signature: Date:

Clinician Signature: Date:

Other participant outcome baseline: Date:

Follow Up Documentation

Date of follow-up:

The participant met behavioral goal 1:

All the Time Most of the time Half the time Occasionally Never

5 4 3 2 1



5 4 3 2 1


Other participant outcome follow up: Date:


Complete Patient Chart Audits per

Multi-site

EMR Charts not printed are covered by the confidentiality agreement signed by the program and the auditor prior to the audit. You will be required to access the electronic charts and stay with the auditor during the entire chart review.


Insert Tab 8





2013 / 6

Standard #8: Ongoing support

The participant and instructor(s) will together develop a personalized follow-up plan for ongoing self-management support. The participant’s outcomes and goals and the plan for ongoing self- management support will be communicated to other members of the health care team.


A. Participants will have aplan for post educationself-managementsupport for ongoingdiabetes self care beyondthe formal selfmanagement educationprocess

1. There must be evidence of apersonalized follow-up plan forDiabetes Self Management Support(DSMS) as part of the educationprocess either within or outside ofthe DSME program.(e. g. of DSMS: worksite programs,support groups, communityprograms, on-line diabetes supportservices, exercise programs,walking groups, follow up withdiabetes educator or referringprovider, etc.)

2. There must be evidence ofcommunication with other healthcare team members(e. g. referring provider, socialservices agency staff, school nurse,etc.) regarding education plan oreducation provided, outcomes andthe DSMS plan.


Findings / Notes:


My Diabetes Self-Management Support Plan

Emotional Support Let your educator know if you need help accessing the websites.

National Alliance on Mental Illness (NAMI) –(Depression, bipolar and other support) 800-950-6264; www.nami.org

Depression & Bipolar Support Alliance- 800-826-3632-www.dbsalliance.org Anxiety &Depression Association of America

o Find a local support groups & Therapist by zip code at www.adaa.orgo National phone number 240-485-1001

National Suicide Prevention Lifeline- 800-273-

8255 Weight Management

Weight Watchers-800-621-6000-www. weightwatchers.com Over eaters Anonymous- 505-891-2664 (support group)- www.oa.org Other:

Exercise

Curves -877-673-3144- www.curves.com 24 Hour Fitness-800-224-0240- www24hourfitness.com Add local gym and fitness center as an option Other:

Diabetes Support Groups

Add local support group information

Stress Relief

Add local Yoga classes

Other

Add other local support resources

Journals

Diabetes Forecast- 800-342-2383- www.diabetesforecast.org Diabetes Self-Management- 855-367-4813- www.diabetesselfmanagement.com Other:

Apps

Calorie King Glucose Buddy (Free, tracks blood glucose, graphs) SparkQuote (Free, inspiring quote for the day)

Patient Name: Date

Communicated to referring provider: _ Date

Adapted from City of Hope National Diabetes Center - Duarte, CA – 4/2015


http://www.nami.org/

http://www.dbsalliance.org/

http://www.adaa.org/

http://www/

http://www.oa.org/

http://www.curves.com/

http://www.diabetesforecast.org/

http://www.diabetesselfmanagement.com/

Insert Tab 9





2013 / 6

Standard #9: Patient progress

The provider(s) of DSME and DSMS will monitor whether participants are achieving their personal diabetes self-management goals and other outcome(s) as a way to evaluate the effectiveness of the educational intervention(s), using appropriate measurement techniques.


A. The DSME/S programmeasures theeffectiveness of theeducationalintervention(s) throughthe evaluation ofgoals/outcomes foreach participant.

1. The DSME program has a process forfollow-up to evaluate and documentat least one of each of the following:

a) Behavioral goal achievement(e. g. Healthy eating, being active,other)

b) Other participant outcome:(e.g. clinical, quality of life,satisfaction)

2. Behavioral goal(s) and otherparticipant outcome(s)assessment is personalized andreviewed at appropriateintervals.


Findings / Notes:



Patient name:







Patient Signature: Date:


Other participant outcome baseline: Date:

Follow Up Documentation

Date of follow-up:



5 4 3 2 1



5 4 3 2 1


Other participant outcome follow up: Date:


Insert Tab 10





2013 / 6

Standard #10: Quality improvement

The provider(s) of DSME will measure the effectiveness of the education and support and look for ways to improve any identified gaps in services or service quality using a systematic review of process and outcome data.


A. The DSME program hasa quality improvementprocess and plan inplace for evaluating theeducation process andprogram outcomes.

1. There is evidence of aggregation of at least one participant behavioral goal and oneother participant outcome.

2. There is documentation of a CQIplan/process (e. g. written policy, annualprogram plan, CQI meeting minutes) basedon at least one behavioral goal or otherparticipant outcome.

B. Quality improvement isbased on regularaggregation of programoutcomes data andapplication of results toenhance quality of theDSME and address gapsin service.

2. There is evidence of aggregated dataand the summary for use or applicationfor improvement of DSME/S

(e. g. description of project, summary ofaggregate data, written plan forimprovement, using data),


Findings / Notes:


Standard 10 Cycle

Aggregated Behavioral Goal

(at least one)

Aggregated Other Participant Outcome

(at least one)

Select at least one of the above for..

CQI Project What are you trying to improve, fix or accomplish?

Target Outcome

Aggregated Outcome

Implement Amendments

Report Cycle as long as you

continue to work on this CQI project

Amend Current Operations

Review Outcome versus Target

Review Current Operations


CQI Project Worksheet

A. Program’s one or more aggregate patient selected behavioral goal outcome

Behavioral Goal Category AND Aggregated Outcome in %:

Add more lines if needed

B. Program’s one or more aggregated other participant outcome

Other Participant Outcome AND Aggregated Outcome in %:

Add more lines if needed.

C. CQI Project

Enter in line below the one aggregated outcome from A or B above to create your CQI project to address

_

List below what your CQI project will be trying to improve fix or accomplish?

D. What is the CQI project target % outcome you are trying to achieve?

_%

E. Determine the CQI project outcomes reporting and review cycle: monthly, quarterly, bi-annually.

a. Reporting and outcome review cycle will be .

CQI Cycle

Top

F. Aggregate outcomes

G. Review outcomes versus target

H. Review current operations as they relate to the CQI project

I. Amend current operations to improve CQI outcomes

J. Implement improvements

Repeat cycle starting with F.

E) ReportingReview Date Enter Date to Report/Review Enter Date to Report/Review

Enter Date to Report/Review


D) CQI Target % % % %

F) CQI Outcome % % % %

G) Review Outcomes

H) Review current operations and consider amendments

I)List amendments to current operations

J) Date change Implemented


Sample CQI Project Worksheet – A1C

A. Program’s one or more aggregate patient selected behavioral goal outcome

• Behavioral Goal Category AND Aggregated Outcome in %: Physical Activity-45%B. Program’s one or more aggregated other participant outcome

• Other Participant Outcome AND Aggregated Outcome in %: A1C- 57%C. CQI Project

• Enter in line below the one aggregated outcome from A or B above to create your CQI project to address A1C

• List below what your CQI project will be trying to improve fix or accomplish? Increase the number of participants with an a1c less than 7%

D. What is the CQI project target % outcome you are trying to achieve? 85%

E. Determine the CQI project outcomes reporting and review cycle: monthly, quarterly, bi-annually.• Reporting and outcome review cycle will be bi-annually.

CQI Cycle

F. Aggregate outcomesG. Review outcomes versus targetH. Review current operations as they relate to the CQI projectI. Amend current operations to improve CQI outcomesJ. Implement improvements


E) ReportingReview Date

June 20 Enter Date to Report/Review

December 20_ Enter Date to Report/Review



D) CQI Target 85% 85% 85% 85% F) CQIOutcome 57 % 64% 79% % G) ReviewOutcomes

93 of the 163 participants had a post DSME A1C less than 7%



H) Reviewcurrentoperationsand consideramendments

How often you should have your A1C tested is reviewed during class 4 of the 5 class series.

Participants liked understanding how the blood sugar level is related to A1C

Participants communicated that they felt empowered with the ability to prevent DM complications once they learned that A1C reduction is directly related to complication reduction.

I)Listamendmentsto currentoperations

Add to the content of the slide deck discussion about what A1C is and average blood sugar level related to the various %.

Add content to class 4 discussing the % reduction in DM complications with each % reduction of A1C

Create A1C patient tracker scale with BG average. Patient will be able to track their bg as well how it relates to their daily readings

J) Change date June 4 15, 20 December 2, 20 Jun 12, 20


Sample CQI Project Worksheet – Physical Activity

A. Program’s one or more aggregate patient selected behavioral goal outcomea. Behavioral Goal Category AND Aggregated Outcome in %: Physical Activity-40%

B. Program’s one or more aggregated other participant outcome• Other Participant Outcome AND Aggregated Outcome in %: Hospital Admissions due to diabetes-75%

C. CQI Project• Enter in line below the one aggregated outcome from A or B above to create your CQI project to address

Physical Activity• List below what your CQI project will be trying to improve fix or accomplish?

Increase the goal achievement rate of the DSME participant’s that select a physical activity goalD. What is the CQI project target % outcome you are trying to achieve?

85%E. Determine the CQI project outcomes reporting and review cycle: monthly, quarterly, bi-annually.

a. Reporting and outcome review cycle will be quarterly.

CQI Cycle



E) ReportingReview Date March 20 Enter

Date to Report/ReviewJune 20 Enter

Date to Report/ReviewSeptember 20_


December 20_ Enter Date to

Report/ReviewD) CQI Target 85% 85% 85% 85% F) CQIOutcome 40% 48% 75% % G) ReviewOutcomes

8 of the 20 participants that selected a physical activity goal met their goal.

25 of the 52 participants that selected a physical activity goal met their goal.

36 of the 48 participants that selected a PT goal met their goal.


Currently the benefits of physical activity is discussed during class 2 of the 4 class series

Amendments noted in March have resulted in improved outcomes but more improvements needed

Participants like June amendments and stated this during class. PT goal outcome data reflected many said they were doing the activities discussed in class during 10 min. after meals or during commercials


Add physical activity handouts to class 2 that recommend various activities and how many calories a 150#, 200# and 250# woman or man burn per 60 minutes of the activity

During the 2nd class show participants how to do one standing in place and one chair exercise for 5 minutes. Ask them if they could do this during commercials or after each meal for 10 mins.

Incorporate 5 minutes of a new chair or new standing in place activity during each of the 4 classes and continue to encourage participants do them during commercials or after meals.

J) Change date March 15, 20_ June 20, 20 September 12, 20


Sample CQI Project Worksheet – LDL

A. Program’s one or more aggregate patient selected behavioral goal outcome• Behavioral Goal Category AND Aggregated Outcome in %: Physical Activity-75%

B. Program’s one or more aggregated other participant outcome• Other Participant Outcome AND Aggregated Outcome in %: LDL-57%

C. CQI Project• Enter in line below the one aggregated outcome from A or B above to create your CQI project to address

LDL• List below what your CQI project will be trying to improve fix or accomplish?

Increase the number of participants with an LDL value less than 100mg/dlD. What is the CQI project target % outcome you are trying to achieve?

95%E. Determine the CQI project outcomes reporting and review cycle: monthly, quarterly, bi-annually.

a. Reporting and outcome review cycle will be quarterly

CQI Cycle



E) ReportingReview Date

March 20 Enter Date to Report/Review


September 20_ Enter Date to Report/Review


D) CQI Target 95% 95% 95% 95% F) CQIOutcome 57 % 64% 79% % G) ReviewOutcomes

93 of the 163 participants had a post DSME LDL less than 100




LDL target is discussed during the preventing Chronic Complications section of the curriculum.

The video spiked DSME participant’s interest and they are asking more resources on which foods help lower LDL.

Participants are asking about plant sterol effects on LDL and food sources


Add video to class discussing LDL to show how it deposits in the vessels.

Create and distribute list of foods high in soluble fiber that can assist with LDL cholesterol reduction.

Create a plant stanol and sterol list for program and each class encourage participant to include either/and a plant sterol food or high soluble fiber food each day

J) Change date March 3, 20_ June 5, 20 September 12, 20
