(From the March 2015 Issue of PediatricsOnline)
As part of a quality improvement initiative in the Section of Endocrinology, Metabolism and Diabetes at Nationwide Children’s Hospital, type 1 diabetes education efforts were evaluated and modified, resulting in dramatic improvement in patient and family “pass” rates on comprehension-based quizzes from about 25 percent to more than 60 percent. The study, published in the International Journal of Diabetes and Clinical Research, suggested that type 1 diabetes education management skills need to be repeatedly emphasized and evaluated for proficiency of learning to ensure that patients and families are able to properly manage care.
With the overall goal of improving diabetes care and outcomes in their patient population, a multidisciplinary team including endocrinologists, diabetes educators, dieticians, social workers and others at Nationwide Children’s aimed to develop an objective assessment tool to measure patient and family knowledge of diabetes management on a daily basis and also on sick days.
“There is no holiday or break from type 1 diabetes; patients and their families have to think about the condition day in and day out,” says Manmohan K. Kamboj, MD, lead author of the study and interim chief of Endocrinology, Metabolism and Diabetes at Nationwide Children’s. “We wanted to make sure our education efforts weren’t confined to completing a checklist and assuming we had really taught them what they needed to know.”
The diverse team divided education and assessment categories into three basic components: general diabetes and physiology knowledge, basic skills for well-day management and strategies for sick-day care. Each month, 20 quasi-random patients with type 1 diabetes and their families were selected to complete vignette-based quizzes to assess knowledge and management skills in each of these areas.
At the start of the study, 25 percent of patients and families stated that they had a department-provided copy of sick-day guidelines, 28 percent of participants received a passing score on the well-day skill quiz, and only 15 percent passed the sick-day skill quiz. In addition, none of the evaluated after-visit summaries given to families included all of the essential components.
The team implemented a variety of interventions over the course of nearly two years, adjusting and expanding their techniques based on monthly analysis. Their methods included techniques such as the following:
By the time of this study’s publication, 100 percent of families had sick-day guidelines in their possession, 85 percent of visit summaries referenced all essential education elements and over 60 percent of patients and their families passed well-day and sick-day quizzes.
“We need to be cognizant of the fact that just teaching something is not enough. We have to make sure that whoever we’re teaching really understands what is being taught by having an evaluation system in place,” says Dr. Kamboj, who also is an associate professor at The Ohio State University College of Medicine. “We continue to evaluate the diabetes management skill levels of patients and families each month in an effort to continue improving our education program. This concept has now become a part of our routine clinic functioning. Physicians and health educators need to assess patients to make sure they understand what they are supposed to be doing once they go home.”
The multidisciplinary quality improvement team is now also focusing on newly diagnosed patients with type 1 diabetes during their initial hospital stay. Dr. Kamboj anticipates expanding the evaluations to include additional diabetes education opportunities at Nationwide Children’s but also sees the method’s potential for improving education in other chronic diseases as well.
“Conditions like asthma, for instance, require constant, situation-based management and skills, and may benefit from similar education processes,” Dr. Kamboj explains. “Many of the techniques we used to test and improve our diabetes education efforts could be adopted for use with other chronic conditions, as well.”
Kamboj MK, Stephens KJ, Brilli RJ, Yarley HL, Lewis J, McClead RE Jr., Repaske DR. Assessment of learning guides improvement in diabetes education program: A QI initiative for type 1 diabetes mellitus in children and adolescents. International Journal of Diabetes and Clinical Research. 2014 Nov 17, 1:2.