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.


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.


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


«Oldest   ‹Older   601 – 637 of 637
Biggboss said...

Bigg Boss 16, the show has rolled out thirteen seasons and two spin-off versions
Bigg Boss OTT Season 2 will be releasing in 2022 only on Voot and Voot Select

Bigg Boss 16 Live

[url=https://biggboss16.live/]Bigg Boss 16 Live[/url]

warren buffet said...


check out my websites

hum tv dramas
ary digital dramas
Geo tv dramas
Dil Zar Zar

Christain said...



Geo tv dramas
Hum tv dramas
Ary Digital Dramas
dil zar zar

clark kent said...


check out my websites

Youtube Music

charley said...

Check these websites
Iphone side
Hania Style

doramas coreanos sub español said...

Estrenos Doramas Net mira antes que nadie los ultimos doramas online en emision y
finalizados, aqui podras ver muchisimos doramas online y novelas coreanas sub español

charley said...

Check these websites
1= Check out my website for the variety of paid APKS for free
Iphone side

2= Check this for latest TV shows update

3= Check this for Wedding Ideas
Hania Style

4= Check this for Dramas

Moizlashari said...


Jessy Kristi said...

Hey, Your blog is very informative. It is nice to read such high-quality content. Our dissertation helpers are well-versed with all the academic topics and always giving great writing for the students. Dissertation providers deliver quality content related to your Dissertation. For more details, you can Click here,
Visit here

Acedata said...

Great post, thanks for sharing such an amazing content with us.
Cloud backup solutions
Backup data
cloud backup pricing

Onestop said...

Thanks for such an informative post
Gate pass management software
accounting software

moolahgeeks said...

Truly amazing post, keep updating us with such amazing content
Best Rewards credit card singapore
Best cashback credit card singapore
Best Credit Card

Nathan Hobbs said...

InShot is one of the best video and photo editing apps for mobile phone devices like android or ios. you can easily download inshot pro apk here

Acedata said...

Such an amazing and great post thanks for the update
Cloud backup service 
Office 365 backup
Cloud backup pricing
Healthcare cloud solutions

Onestop said...

For accurate accounting opt for Onestop Accounting software
accounting software india
accounting software online india
Gate pass management

Altoindia said...

Alto india's Magnetic track light system is one of the latest trends in flexible track lighting applications.
These are handpicked for quality and performance which enhances the functionality and aesthetics of your space,along with catering to the visual comfort of the occupants.
Magnetic track light price
Magnetic track lighting

Altoindia said...
This comment has been removed by the author.
eversure said...

iv catheter manufacturers in india
iv cannula manufacturer in india
iv catheter parts manufacturers

rathi said...

Amazing blog
iv cannula price in india
surgical disposable products manufacturer in india
disposable medical devices manufacturers
iv catheter parts manufacturers

Zara Social said...

check out my articles



Altoindia said...

Alto india's Magnetic track light system is one of the latest trends in flexible track lighting applications.
Magnetic track light
Magnetic track light india

gashet said...

p6h36c2e08 x0a83g7e74 o8a06y6b45 v5e51o0i32 a9i19n5t67 k8m38w7b65

kailash said...

My first time I visit here. I found so many entertaining stuff on your blog, especially its discussion.
Difference Between HDPE and PVC

Acedata said...

Acedata Cloud Backup services are designed for every industry and for all sizes of business.
Data Backup
Cloud backup pricing

Onestop said...

OneStop Global solution for accounting and gate pass management software
Visitor Gate Pass
accounting software online india

osumare556 said...

Osumare- top 10 digital marketing companies in pune
top seo company of pune
best digital marketing company in pune

Sgnco Ltd said...

SGNCO Ltd. provide inspection and certification solutions.
Ferrous scrap prices
Pre shipment inspection companies

Altoindia said...

Alto india's Magnetic track light
system is one of the latest trends in flexible track lighting applications.
Profile Light
Magnetic track light india

Jane Wilson said...

Thanks for a nice posting! Do you require help with a history case study help?
Don't give a damn about that. Contact our specialists for technical assistance with your history case study. Don't be hesitant to ask for assistance!

osumare556 said...

Great post
digital marketing companies in pune
seo companies in pune

Doramasviphd said...

DoramasVIPHD Watch online , Japanese,Chinese, Thailand and Hongkong dramas with English Subtitles in

Mosharof said...

Read IELTS Topics & Answers:
I Read Online
Academic Exercise

Expert Previews said...

Read Dialogues Online: Expert Previews

TrueBalance said...

Really great post, thank you for sharing. Looking for personal loan apps india visit TrueBalance

TJC Group said...

Great post by the author. Thanks for sharing. Looking for sap s/4hana migration visit TJC Group.

Unknown said...

hey if you are looking for a digital marketing agency visit #ARMWORLDWIDE

Unknown said...

thanks for posting if you are looking for a Online Image Management Services visit #armworldwide

«Oldest ‹Older   601 – 637 of 637   Newer› Newest»