<p> Diabetes Management: PDSA Activities</p><p>Use this tool to guide you through simple quality improvement (QI) activities for improving diabetes management in your practice using the Plan-Do-Study-Act (PDSA) methodology.</p><p>PLAN</p><p>1. What do you want to accomplish? Make sure you are crystal clear and be realistic about completing the project. Be sure it can be easily measured. 2. Identify the people, time and resources required. 3. Analyze the process or problem you are trying to improve. Decide what measure you will use to determine the impact of the change. Estimate how long you will need to track these to see results. Use this measure for baseline and endpoint data (e.g., 6-12 weeks). 4. Discuss and decide with your team the change you all feel will lead to improvement in your baseline measurement. Plan the details of the intervention. 5. Example: We want to increase our pneumonia vaccination rate from 50 percent to 70 percent over the next six weeks.</p><p>DO</p><p>1. Make sure that everyone understands the changes that will be made during the PDSA cycle. This may require training in the new process or system. 2. Keep the team engaged in the new way of doing things with regular communication. 3. Let the new process or system run for a while before you jump to conclusions about whether or not it is working. 4. Keep monitoring your metrics and don’t analyze them prematurely. Try to measure a select number of metrics on a weekly basis. 5. Example: During pre-visit planning, the team identifies which patients are due for a pneumonia vaccine. These patients are given a vaccine information statement (VIS) upon check-in.</p><p>STUDY</p><p>1. Once you have enough data to assess the impact of the change on the selected metrics, you should be able to determine if there has been any significant improvement. 2. The most important aspect of this part of the cycle is seeing what new insights come to light about the process during the test. 3. Example: Pick one day each week and see if pre-visit planning has been done and the new change is working. Develop a weekly run chart (see examples below) to keep track of the effort. Measure fewer patients’ charts than at baseline or mid/endpoint.</p><p>ACT</p><p>1. Often this step gets short-changed because people are anxious to get started on the next project. If you have made a change that is clearly an improvement, figure out how to “hardwire” it into the process or system in the future. 2. Once you have completed the first PDSA cycle, consider starting another on the same process until you have optimized your practice performance. Many people think that a single cycle is enough, but it rarely is “one and done.” Try another small intervention! 3. Example: After six weeks, your team re-measures and finds that your pneumonia vaccine percentage went from 50 to 60 percent. Though this is 10 percent less than you hoped, be sure to gather the team to celebrate the success and brainstorm about what worked and what didn’t. Then start the next PDSA cycle with the same goal but perhaps a different intervention. </p><p>1 Copyright 2017 American Medical Association. All rights reserved. Diabetes management activity directions: 1. Initiate an activity with your team. a. Introduce Plan-Do-Study-Act. b. Review diabetes education. c. Make sure to include non-clinical team members that may be impacted by this activity.</p><p>2. Choose one of the surveys to use in your QI cycle. a. There are nine sample surveys attached to this activity. You can change the survey questions to meet your practice needs and interests. b. Determine how long your QI cycle will run.</p><p>3. Ask/help your front desk staff to identify patients with a diabetes diagnosis during the checkout process. Staff should hand the survey to the first 30 patients and request that they fill out the survey and return the form before leaving the office. a. If it will be difficult for your check-out staff to identify this patient population, you can give the survey to all patients and only tabulate the ones from patients with diabetes. a.i. If you take this approach, you’ll need to ensure you have enough completed surveys for the activity sample size (10-30 surveys completed by patients diagnosed with diabetes). a.ii. Add: “Only answer this form if you have been diagnosed with diabetes.” to the top of your survey before distributing to patients, so you’ll only receive completed surveys from the desired patient population. a.iii. You could also add the following introductory question to the beginning of your survey: a.iii.1. Have you been diagnosed with diabetes? a.iii.1.a. Yes a.iii.1.b. No If yes, please answer the following questions.</p><p>4. At week zero (baseline), print 10-30 copies of each survey chosen and have the front desk hand it out to patients during check out. a. Measure the metric(s) chosen. b. Deliver staff education on diabetes management including the Steps Forward module.</p><p>5. At week six, print 10-30 copies of each survey chosen and have the front desk hand it out to patients during check out. a. Measure the metric(s) chosen.</p><p>6. At week 12, print 10-30 copies of each survey chosen and have the front desk hand it out to patients during check out. a. Measure the metric(s) chosen.</p><p>7. You may choose to give a smaller number of surveys (~10) to patients on one day a week so that the team can see weekly how the activity is going and if it is working. Consider using a “tick chart” or run chart to track your progress. Post the chart in a common area to remind and motivate the team!</p><p>2 Example tick/run chart:</p><p>To start - only choose ONE of the following surveys. It saves time when the patient is doing the measurement!</p><p>3 Copyright 2017 American Medical Association. All rights reserved. Questions to improve diabetes care: Form A We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>1. Were you asked to remove your shoes before the doctor entered the room? a. Yes b. No</p><p>If you answered yes and you removed your shoes, please continue:</p><p>2. Did the doctor or staff examine your feet? a. Yes b. No</p><p>4 Questions to improve diabetes care: Form B We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>1. Many patients find it difficult to take their medications as directed every day. Were you asked if you were taking your medications as directed? a. Yes b. No</p><p>5 Copyright 2017 American Medical Association. All rights reserved. Questions to improve diabetes care: Form C We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>1. Were you asked to bring all of your medications to this visit? a. Yes b. No</p><p>If you answered yes, please continue:</p><p>2. Were you able to bring your medications today? a. Yes b. No</p><p>If you answered yes, please continue:</p><p>3. Did our staff look at all of your medications? a. Yes b. No</p><p>6 Questions to improve diabetes care: Form D We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>1. Did anyone on our staff ask you if you knew what the A1C test means? a. Yes b. No</p><p>2. Did anyone on our staff discuss with you what your A1C level should be? a. Yes b. No</p><p>3. Do you know what your A1C level should be (your goal)? a. Yes b. No*</p><p>If you answered yes to #3, please write your goal A1C level here (the goal, not what it is now): </p><p>______</p><p>*If you don’t know what your goal A1C level is, the doctor should tell you at your next visit.</p><p>7 Copyright 2017 American Medical Association. All rights reserved. Questions to improve diabetes care: Form E We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>1. When people start taking medications for diabetes, they often need to take them for the rest of their life. Has anyone on our staff told you that some of your medications may be needed for the rest of your life? a. Yes b. No</p><p>8 Questions to improve diabetes care: Form F We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>1. Did anyone on our staff ever ask you if you knew what your fasting blood sugar level should be? a. Yes b. No</p><p>2. Do you now know what your fasting sugar level (your goal level) should be? a. Yes b. No*</p><p>3. If you answered yes to #2, please write the number here (your goal level, not what it is today): </p><p>______</p><p>*If you don’t know what your goal fasting sugar level is, the doctor should tell you at your next visit.</p><p>9 Copyright 2017 American Medical Association. All rights reserved. Questions to improve diabetes care: Form G We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>1. Has anyone on our staff ever told you how much sugar is in soda or juice? a. Yes b. No</p><p>2. Did anyone on our staff ever show you how much sugar is in soda or juice? a. Yes b. No</p><p>10 Questions to improve diabetes care: Form H We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>*This is an anonymous survey. No one will know which of our patients answered the questions.</p><p>Occasionally, patients do not take their medication for one reason or another. Providers do not always ask if their patients are taking their medicines as directed and moreover, patients often do not tell their provider if they have missed taking medicines.</p><p>1. Did your doctor or anyone on our staff ask you today if you are taking your medications as directed? a. Yes b. No</p><p>If you answered yes, please continue:</p><p>2. Did you tell the doctor how you are really taking your medications? a. Yes b. No</p><p>11 Copyright 2017 American Medical Association. All rights reserved. Questions to improve diabetes care: Form I We care about your experience here. You can help us improve the care we provide by answering a few questions. Thank you for your time!</p><p>1. Were you asked how much physical activity or exercise you get each week? a. Yes b. No</p><p>2. Did your doctor discuss with you some ideas to increase your physical activity? a. Yes b. No</p><p>12 Blank run chart</p><p>Source: AMA. Practice transformation series: diabetes management. 2017.</p><p>13 Copyright 2017 American Medical Association. All rights reserved.</p>