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AADE Board Adopts Chronic Care Model
The recent Environmental Scan and National Practice Survey have provided
many insights into the practice of diabetes education, but none more than the
need for the profession to move away from the acute care model toward one that
is more reflective of current needs and
realities.
Both the scan and survey showed us that the hospital setting and its emphasis on acute care is becoming increasingly difficult to justify and hard to sustain. It also revealed that those of you who remain working in the hospital setting are under increasing pressure to be more productive and show a profit. And, in fact, many of you have already made the move to other practice settings. To address our members' needs, we decided to examine the various ways diabetes education is being delivered and search for a model that best serves the profession, the professional, and the patient.
In looking around, it became increasingly evident that diabetes education is poorly understood outside of the hospital-based model. There is very little standardization and consistency and almost no measurement of efficacy. Counseling and support are being provided to patients—many times by their family physician, clinic, or pharmacist—but standards for education and best practices for delivery need to be defined. In our pursuit of a better model for patient care, we worked with organizations that are studying chronic care patient self-management training and support out in the community, including one by The Robert Wood Johnson Foundation called the Diabetes Initiative (http://rwjf.org/research). This project and others have found that to be effective, you need to make a connection with the patient. This often means expanding the health care team to include paraprofessionals. After much research and thought, the AADE Board of Directors put its stake in the ground last month by declaring that the association believes people with diabetes should be treated with the Chronic Care Model (http://improvingchroniccare.org), in which the focus is the patient-provider interaction and the care is coordinated with the health system and the community. The Chronic Care Model will help us move the profession of diabetes education into a more community-based setting, one that deals more with primary care than with hospital-based care, defines the primary care team more broadly, and most important, one that gets us away from taking an acute-care approach to a chronic disease.
The Chronic Care Model was created by Improving Chronic Illness Care, a national program of The Robert Wood Johnson Foundation based in Seattle at the MacColl Institute for Healthcare Innovation, at Group Health Cooperative. The model was the brainchild of Ed Wagner, MD, MPH, FACP, a respected leader in chronic disease care and evaluation. The Improving Chronic Illness Care program grew out of Group Health Cooperative's experience with population-based care for the chronically ill. The Chronic Care Model summarizes the basic elements for improving care in health systems at the community, organization, practice, and patient levels. Please take a moment to familiarize yourself with the Chronic Care Model (http://improvingchroniccare.org/change/index.html).
Our next move is to take the model and adapt it to our professional setting. Toward that end, AADE will be producing a position paper describing the role of the diabetes educator within the Chronic Care Model. We will also be inviting members to engage with us in conversation about effective ways of implementing the model. We are also in the process of developing a memorandum of understanding with the MacColl Institute for Healthcare Innovation that will describe the expanded care team. We will be focusing on the health care team's tasks, training for the tasks, measuring competency, and certifying mastery of knowledge. The diabetes educator will be an integral member of the team. We will also begin looking at the financial component, determining how diabetes educators will be paid for their services.
We feel strongly that to keep the profession alive and healthy, we need to move it into the primary care setting and into the community because that is where people with diabetes are. All our investigative work has shown us that the degree to which a health care provider is close to a patient is the degree to which they will be effective in helping someone be a successful self-manager. The Chronic Care Model understands this by promoting the team approach—a team that brings community members into the process but that has diabetes educators leading the effort.
While we are working on the national issues, we ask that all AADE members do a few things:
We hope that you see the benefit in partnering with community health workers. Remember that with a diabetes population at 20 million, there are definitely not enough caregivers to go around. One of the most valuable roles a diabetes educator can play is to extend their skills set to other people so that more people can receive the care they need.
The Diabetes Educator, Vol. 32, No. 1,
35-36 (2006) This article has been cited by other articles:
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