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Iabetes Education Centres Across the Province of N E W B R U N S W I C K

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Iabetes Education Centres Across the Province of N E W B R U N S W I C K e aluation of the effectiveness of iabetes Education Centres Across the province of n e W B r U n s W i c K Table of Contents Acknowledgements and Author Details 4 Foreword 6 Key Messages, Findings and Recommendations 7 1 Introduction 9 comprehensive integrated care for diabetes 11 What is best practice for diabetes care 11 2 How the findings were arrived at 13 Where enhanced diabetes care and education is provided 15 3 Care provision in New Brunswick, main findings 16 Alignment with the chronic care model 46 4 Diabetes outcomes in New Brunswick according to service characteristics 48 Geographic differences in A1c levels 49 comparing individuals receiving or not receiving enhanced diabetes care 55 outcomes according to type of clinic 57 cost of care 59 5 What do the more effective clinics look like in New Brunswick 60 6a Appendix A: Glossary 63 6b Appendix B: Methodology 66 6c Appendix C: Questionnaires 72 6d Appendix D: Clinic Profiles 80 Large clinic 81 small hospital 134 community health centre 195 health centre 232 case Manager 258 pediatric 266 Acknowledgements and Author Details The New Brunswick Health Council mandate Authors: New Brunswickers have a right to be aware Michelina Mancuso, BSc PT, MSc, MBA of the decisions being made, to be part of the Project Lead, decision-making process, and to be aware of new Brunswick health council the outcomes delivered by the health system Denise Donovan, M.P.H. and its cost. The New Brunswick Health Council centre de formation médicale du nouveau-Brunswick will foster this transparency, engagement, and accountability by: Beverly Greene, RN, BN, MN new Brunswick Department of health • engaging citizens in a meaningful dialogue. • Measuring, monitoring, and evaluating population health and health service quality. • informing citizens on health system’s performance. • recommending improvements to the Minister of health. Acknowledgements: t his report and the ongoing measurement and monitoring of the comprehensive Diabetes strategy are the products of many collaborative efforts. the authors wish to acknowledge the contributions of members of the Diabetes task Group, the support from senior executives of both regional health Authorities (vitalité health network and horizon health network) with special thanks to nicole Labrie and Denise connors. We also wish to thank James Ayles and his team (Medicare data), John Boyne and his team (hospital data), sara smallwood (chief privacy officer for health) and facilicorpnB for diabetes clinic data extraction support. 4 Evaluation of the Effectiveness of Diabetes Education Centres Across the Province of New Brunswick content support: technical support: Michel Arsenault, MSc (Qualitative Researchers-Clinic Profiles) Statistical Lead, new Brunswick health council Marie-Hélène St-Amand, MQo research Stuart Halpine, BA, MA, PhD Research Consultant, Craig Wight, nB Department of health MQo research Jeff Campbell, BBM Cora Cole, MSc. C.H.P., C.M.C, Chronic Disease Business Analyst, Move the Median Business consulting & coaching nB Department of health Karine Leblanc Gagnon, BSc Mathieu Bélanger, PhD MAPS, Information Analyst, Epidemiologist, new Brunswick health council centre de formation médicale du nouveau-Brunswick Lise Collette-Lee Jalila Jbilou, MD, MPH, PhD Report Formatting & Graphic Design, Assistant Professor, studio tandem school of psychology (Université de Moncton) and centre de formation médicale du nouveau-Brunswick New Brunswick Health Council pavillon J.-raymond-frenette 100 des Aboiteaux street, suite 2200 Moncton, new Brunswick e1A 7r1 phone: 1.877.225.2521 1.506.869.6870 fax: 1.506.869.6282 www.nbhc.ca How to cite this document: Evaluation of the Effectiveness of Diabetes Education Centres Across the Province of New Brunswick (NBHC 2014) Cette publication est disponible en français sous le titre : Évaluation de l’efficacité des Centres d’éducation sur le diabète dans la province du Nouveau-Brunswick (CSNB 2014) 5 Foreword In June 2012 the New Brunswick Health the main objective of the project was to evaluate the Council (NBHC) began a project to assess effectiveness of diabetes education centres and clinics in the delivery of services for patients with new Brunswick, in order to help inform the Department of diabetes in New Brunswick. This work falls health’s (Dh) and the regional health Authorities’ (RHA) efforts under the legislated mandate of the NBHC to to improve the quality of diabetes related health services in promote the improvement of health service the province of new Brunswick. As such, the project was quality in the Province by: carried out with the collaboration of the Department of health and both regional health Authorities in new Brunswick. • engaging citizens in a meaningful dialogue, this collaboration included, in the preliminary phase, a privacy • measuring, monitoring, and evaluating impact Assessment completed to establish the parameters population health and health service quality, for data sharing and provide the basis for the agreements between the nBHC and the Dh as well as between the nBHC • informing citizens on health system’s performance, and the RHAs. • recommending improvements to health system partners. This document is the report of the NBHC’s Evaluation of The NBHC seeks to foster transparency, the Effectiveness of Diabetes Education Centres Across engagement and accountability in order the Province of New Brunswick based on the context of the to ensure that New Brunswickers can services and the input of resources. The report is intended exercise their right to be: to support further planning by enhancing the information that Regional Health Authorities already collect in their • aware of the decisions being made, performance management systems, by describing the • part of the decision-making process, equity in distribution of services and, in light of the Diabetes Strategy, by indicating which models of care and • aware of the outcomes delivered by types of service achieve the best outcomes. It aims to: the health system and its cost. 1. Describe the geographic distribution of the types of service and their context, 2. Describe the extent to which diabetes services respect the expanded chronic care model, 3. Determine if diabetes services improve the health outcomes of people with diabetes, 4. identify models and practices that produce the better outcomes. 5. Quantify the human resource costs of diabetes care in the 8 largest diabetes centres in the province. 6 Evaluation of the Effectiveness of Diabetes Education Centres Across the Province of New Brunswick Key Messages, Findings and Recommendations Messages: findings: • people with diabetes in new Brunswick who are • Zone 4 (Madawaska/north-West Area) Zone 6 attending diabetes education clinics or centres are (Bathurst/Acadian peninsula Area) have the highest often individuals with complex problems who require proportion of diabetes patients reaching A1c target enhanced or specialized diabetes care. levels. this holds true after adjusting for age in the population. • Degree of patient-centredness and alignment with the chronic care model seem to influence health • patients with diabetes attending clinics achieve larger outcomes that diabetes services achieve. reductions in A1c levels within a 2 year time period compared to those who do not attend clinics. • the actions common to those diabetes services that efficiently use human resources and achieve good • case managers, community health centres and health outcomes include: clinics in small hospitals have the highest proportion of patients with A1c levels of 6 to 8%. this holds true 1. Using a holistic approach in developing a good after adjusting for age and for the A1c level at the start relationship with patients, of receiving service. 2. sharing power and responsibility with the • Large clinics, case managers, community health patient for disease management, centres and clinics in small hospitals achieve similar 3. ensuring flexibility in the offering of services to reductions in A1c levels among their patients. health encourage patients to use them, centres show the smallest reduction levels. 4. establishing and maintaining strong links • in terms of hospital admissions for diabetes with other health services and community related conditions, Large clinics, clinics in resources, small hospitals and community health centres 5. organizational and cultural environment that achieve significant reductions. enables staff to be person centred in the way they work. • Among the 8 large clinics in the province, personnel costs ranged from $30 to $160 per visit. higher costs were not related to better health outcomes. 7 recommendations: • identify role of each location that offers diabetes • implement systems that enhance formal and informal services and its relationship to other diabetes communication between diabetes team members, services. in doing so, consider also the relationship including the patient and family, as well as with the to other health services. inform patients, family wider community and with surrounding health services. physicians, primary care services and other relevant consider the use of electronic health records (eMr) as health services of this role. a method of communication between professionals. • implement in all locations, systematic quality • implement systems that remind patients and improvement programs that target population health professionals of required interventions and actions outcomes and evidence-based practice. Major and when they are due. this would
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