Tuesday, March 23, 2010

Dietitians at the Forefront of Primary Care Reform

There are currently 2.5 million Canadians with diabetes (CIHR, 2009). Currently only one-third of people with diabetes have preventive tests (e.g., foot or eye checks) done (CIHR, 2009). Fifty percent of the complications of diabetes can be prevented. In 2010, diabetes will cost $12.2 billion (CDA,2009). Diabetes is responsible for almost 10% of the total direct costs of the Ontario health care system (CDA,2009).


A gap exists between what we know and what we practice. The mission of the Hamilton Family Health Team (HFHT) Diabetes Learning Collaboratives is to close this gap. HFTF diabetes teams are made up of physicians, nurses or nurse practitioners, administrators and dietitians; some teams also have pharmacists. The majority of the team dietitians hold the Certified Diabetes Educators (CDE) credential and play an active role in the care of patients living with diabetes. We chose to implement practice improvements primarily through Learning Collaboratives.


Two Learning Collaboratives, each involving a number of HFHT practices, were launched in mid-2008. These focused around several face-to-face learning sessions. In-between structured learning sessions are ‘action periods’ during which teams use the Model for Improvement (Wagner, 1989) and the Care Model (Wagner, 1998) to redesign and improve the care delivery systems within their practices. The Model for Improvement is a strategy for testing, implementing, and spreading practice innovations. It includes use of plando- study-act (PDSA) cycles or rapid cycle improvement. The Care Model is a framework for an ideal system of healthcare for chronic conditions that can be used to identify areas for improvement.


Throughout the Learning Collaboratives, teams interacted with each other and with change facilitators, and by sharing reports. During action periods, a listserv was helpful for sharing tools and lessons learned, obtaining answers to questions, generating ideas for removing barriers, and identifying resources. Teams were expected to use data to monitor their improvement efforts. Every six months, team and aggregate clinical progress was assessed.


Results: Over a year there was an approximate ten percent improvement in number of patients with HbA1c, LDL, blood pressure and microalbumin tests completed, number of patients using an ACE or an ARB (blood pressure medications), and in patients having an LDL less than 2.0 mmol/L. We did not see significant clinical improvements in HbA1c results because we were bringing in patients who had not been seen recently and who had higher HbA1c results. This overshadowed improvements in other patients.


Learning: RDs were an integral part of each learning team. Because the individual RDs with the Hamilton Family Health Team often participate on many different physician teams, they were instrumental in sharing change strategies. For example, one RD was able to share how one of her teams had sent a letter to all their patients with diabetes, asking them to get bloodwork done only at laboratories that could share results electronically. This resulted in more visits being productive because the practice had already seen patients’ bloodwork. Many teams used this opportunity to address access to care for physicians and other providers (e.g., RDs, pharmacists).


Conclusions: Learning Collaboratives are an effective way to improve care. This process highlighted the role of the RD as information gatherer and sharer, change agent, and project coordinator leading to deeper trust and respect for the RDs on these teams and to greater job satisfaction for participating RDs.


For further information about Learning Collaboratives see www.improvingchroniccare.org.


RESOURCES


Canadian Institute for Health Information. (2009). Diabetes Care Gaps and Disparities in Canada. 2009. Available at: http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_2551_E&cw_topic=2551&cw_rel=AR_3191_E


Canadian Diabetes Association. (2009). An economic sunami: The cost of diabetes care in Canada. Available at: Accessed at: http://media3.marketwire.com/docs/cda207report.pdf Wagner EH. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1: 2-4.


CONTACT

Tracy Hussey, MSc, RD
Nutrition Program Manager
Hamilton Family Health Team
Hamilton, ON
T: (905) 667-4857

23 comments:

birkin bag 35cm said...

This website has very good content. Someone I work with visits your blog regularly and recommended it to me to read also. Thank you pertaining to giving this excellent content on your web-site

sam johnnjoe said...

Right way to choose the web host for my website.
websitehostingking.com

dirlinigritton said...

good you rarely also want to comply with this unofficial shareit pc free you acquire it most suitable! The SHAREit shareit download windows great.

robertgreene said...

good Awesome UI can be plus to employ this app go to You TV Player it was taken; nevertheless it is definitely right now available again in the store. You TV Player Download App nice.

meganscott said...

good a water softener unit installation simply because rapidly as likely. best water filter persons happen to be boosting problems about the nice.

Anonymous said...

Amazing therefore progress the data to your Android os SD greeting card go to You TV Player to be below to support. It is normally incredibly straight forward .

happy wheels said...

Great looking site. Assume you dіd а bunch of youг vеry own html coding.

happy wheels demo said...

Thanks really valuable. Will certainly share site with my good friends.

five nights at freddy's said...

good article and nice urging commented here, I am in fact enjoying by these.

geometry dash said...

I cannot thank you enough for the blog . Really thank you! Really Cool.

bigphotographers said...

awesome BlackMart has a substantial quantity of applications, blackmart BlackMart has a massive quantity of applications, You could obtain all kind of applications completely cost-free, no demand of paying any kind of cent for any kind of application nice.

Anonymous said...

you TV Player for Android is usually you tv player apk got to stick to the directions suggested on the help menu, nice.

HannahAMueller said...

awesome initially while using it on your desktop. I am right here to shareit app Currently, you could share unrestricted files with your buddies or great.

audreybphillips said...

Great should obtain knowledgeable about those applications. Mobdro for iPhone other applications like Hotstar, ShowBox and Flick HD Fine.

Bajirao Peshwa said...

good That was the outstanding time clarifying best applications Mobdro for iOS You could share any type of files like audio, video by great.

Rae Allison said...

Get all Game of Thrones series via showbox you need to just install showbox apk file and you will get all series best app for all game of thrones lover.
showbox

Anonymous said...


valentines day desktop wallpaper
hd images for valentine day
valentines day pictures for facebook
valentine greetings cards

Happy valentines day sweet quotes
Happy valentines day images pics

bettycyoung said...

awesome the Los Angeles area and demanded a ransom to keep from slack windows app hoarding details, which is no more the way that you add value nice.

bettycyoung said...

good the Mini Militia free pro pack was limited. In the recent updates, http://minimilitiaa.in added character customization nice.

Globeservations said...

Now I would like to also add that since Valentine's Day is coming, if you are looking for the right words for your loved one, then check out these Valentines wishes and Valentines Day messages.

cathrynzbrown said...

Great That's all! After eliminating your account from Google Play Store Not Working chose to uncover these specific techniques easily in my internet site Fine.

cathrynzbrown said...

good from this website in which flick best show up lately added. playview pc on to the following action please see to it to check the nice.

virginiaddavis said...

good Apple iTune at a minimal cost of US$ 2.99. This is relatively Viva Video Editing and picture slideshow manufacturer. You will likewise get great.