Full Report

DIABETES
Figure 6
Pre- and Post-training Outcomes (PACIC)
ALWAYS
MOST OF
THE TIME
5
4
Patient Assessment
of Chronic Illness
Care (PACIC)
SOME OF
THE TIME
A LITTLE
OF THE
TIME
NONE OF
THE TIME
3
2
1
Pre training
Post training
0
Overall
score
Patient
activation
Delivery
system design
Goal setting/
tailoring
Problem
solving
Follow-up/
coordination
PACIC evaluates the extent to which patients receive care that is consistent with the elements of the ECCM. Results show increases in the overall score,
patient activation, goal setting and follow up. Decreases in delivery system design and problem solving may be related to the fact that respondents have
a better understanding of the challenges of chronic care as a result of training. The decrease may also be related to the IP focus, which was the integration
of skills into current practice and not delivery system design. It is common for scores to decrease when first repeated, especially when a tool is used before
and after a period of focus on improving chronic care systems.
Staff turnover was also an issue as it resulted in change
in some pilot leads and left some team members
unsure who to approach when questions or challenges
arose; however, most staff agreed that the Department
project leads were critical champions to keep the three
pilot communities connected and engaged in the
project. 54 Overall, a clear message from staff is that the
development of strong, committed and supportive
leadership at the local and system levels is essential if
SMS is to expand across multiple regions. 55
Despite challenges related to changing leadership
and staff turnover, the pilot teams were able to
integrate SMS skills into their practice (Figure 6).
What we found
The diabetes improvement project has trained
a cohort of frontline and department staff in SMS
delivery through a standardized approach. Team
members have emerged as champions for change in
the delivery of care. Their support, through action, is
advancing a quality improvement strategy that directly
affects patient care and health outcomes.
Team members have emerged as champions
for change in the delivery of care.
The design and implementation of the pilot projects
created opportunities for staff to build new relationships. 56
The overall process brought managers, senior department
staff and frontline providers together, improved mutual
understanding, and created common ground for sharing
experiences and ideas. 57 One staff reported that the
training had changed their approach to chronic disease.
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Making the Case for Change