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

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◦ Process vs Outcome

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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

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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

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Simple Descriptive,
Process Design
Retrospective
Sample Design
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Quality is more than conformity
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Addresses root causes not symptoms
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Improve the process to solve the problem!!!
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AADE 7
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Everything and Anything is part of a process
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Remember 90% of the problems are the process, not the people.

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Being Active
Healthy Eating
Taking Medication
Monitoring
Problem Solving
Reducing Risks
Healthy Coping

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Patient / Client
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SMART-Specific,
Measurable, Achievable,
Realistic, Timebound
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Reviewed with each encounter – determine achieved, progress made, LTF, or revised.
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Individualized
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In God we trust…
In all others, bring data

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

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

Healthy Coping
Problem Solving
Taking Medication
Monitoring
Risk Reduction
Healthy Eating 35%
Physical Activity 21%
Physical
Monitoring 20%
Activity
Risk Reduction11%
Taking Medication
7%
Problem Solving 5%
Healthy Coping 2%
Eating Healthy

5 (Always)
% Achieve 1
(Never)
2 (Rarely)
3
(Sometimes)
Always 35%
Usually 30%
Sometimes 22%
Rarely 8%
Never 5%
4 (Usually)

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Big 3 67% 
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76% (increase) 
Risk Reduction 1.3%  
11% (increase) 
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Healthy Coping 3
Healthy Eating 21
Monitoring 18
Phys Activity 19
Prob Solving 5
Risk Reduction 19
Take Meds 7
All 92
2
4
2
19
3
3
3
2
40
21
29
21
100%
10
17
16

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

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

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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

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

Next……………
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Develop a Plan
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Implement the Plan

2.
3.
4.
6.
7.
8.
1.
5.
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).

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Improve our outcomes language
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Clear understanding of the Education Process:
- Assess  Plan  Implement  Evaluate  Follow up
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Establish Process - setting goals, measuring achievement- documentation- using the information for improvement!