DEVELOPMENT OF A PHYSICIAN OFFICE VISIT DIABETES EDUCATION CURRICULUM FOR MEDICAL ASSISTANTS AND EVALUATION BY EXPERT REVIEW Público

Gonzalez, Amparo B (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/1n79h4495?locale=es
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Abstract

Abstract

DEVELOPMENT OF A PHYSICIAN OFFICE VISIT DIABETES EDUCATION CURRICULUM FOR MEDICAL ASSISTANTS AND EVALUATION BY EXPERT REVIEW

Diabetes management requires the person with diabetes to assume responsibility for self-management of the condition; this includes obtaining knowledge, skills and changing current unhealthy behaviors for healthy diabetes care practices. Diabetes self-management training (DSMT) addresses the behaviors of healthy eating, being active, taking medications, problem solving, healthy coping and reducing risks.The Physician Office Visit (POV) is an ideal setting to initiate DSMT. The curriculum development process was initiated with a brief needs assessment that included stakeholder groups - medical assistant (MA) as the intended end user and the decision maker group; those with the power to implement this change into a delivery care model. The questions addressed issues of when during the POV could the education take place and what topics could be included. The curriculum was developed following Ralph Tyler principles and the instructional objectives were created following Robert Mager's systematic derivation of instructional objectives method. The evaluation consisted of presenting the curriculum materials to a group of diabetes education experts who provided their opinions on the content and completeness of the materials and this constituted the formative evaluation of this thesis project. The findings from the brief needs assessment show that both stakeholder groups identified as the most appropriate routine task to perform diabetes education during the vital sign checks, while the patient is in the exam room and during the discharge process. The evaluation by expert review recommended that the scope of practice for the MA in diabetes education had to be defined, that it had to be tied to competencies and to a capacity training program.The group was clear that this level of diabetes education provider was to transmit and not interpret information. The group also settled that the process was to create a conceptual model that would guide the curriculum constructs and content.

Table of Contents




Table of Contents
Figures and Tables........................................................................................................................ 9
Chapter I- Introduction.............................................................................................................. 10
Introduction .......................................................................................................................................... 10
Behavior Change Theory ..................................................................................................................... 11
Understanding Diabetes ....................................................................................................................... 12
U.S. Health Policy Agenda ................................................................................................................... 13
Diabetes a Chronic Condition ............................................................................................................. 13
Diabetes Self-management Education ................................................................................................ 14
The Physician Office Visit.................................................................................................................... 14
The Medical Assistant .......................................................................................................................... 16
U.S. Models of Care.............................................................................................................................. 16
Barriers to DSME................................................................................................................................. 16
Diabetes Education Guidelines............................................................................................................ 17
DSME Curriculum ............................................................................................................................... 19
Definitions of Terms ............................................................................................................................. 21
Chapter II- Literature Review................................................................................................... 25
Background ........................................................................................................................................... 25
Health Disparities and Social Determinants ...................................................................................... 27
Diabetes Self-management Education ................................................................................................ 28
AADE 7™ Self-care Behaviors............................................................................................................ 30
Access Barriers to DSME..................................................................................................................... 33
Medical Assistants ................................................................................................................................ 35
Chronic Care Model............................................................................................................................. 35
DSME in Primary Care ....................................................................................................................... 37
Delivery Models in Healthcare .......................................................................................................... 37
Current DSME Curricula ................................................................................................................... 38
Life with Diabetes .............................................................................................................................. 39
The Stanford Patient Education Research Center ............................................................................. 39
American Association of Diabetes Educators.................................................................................... 40
International Diabetes Center Park Nicollet Basics of Diabetes ...................................................... 40
Conversation Maps- Healthy I ........................................................................................................... 40
Joslin Diabetes Center ....................................................................................................................... 42
Project Dulce ..................................................................................................................................... 43
Alliance for Hispanic Health ............................................................................................................. 44
Amigos en Salud ................................................................................................................................. 44
Designing the Curriculum.................................................................................................................... 45
Social Cognitive Theory ....................................................................................................................... 47
Curriculum Development .................................................................................................................... 47
Chapter III- Methodology.......................................................................................................... 49
Introduction .......................................................................................................................................... 49
IRB Clearance....................................................................................................................................... 49
Research Design.................................................................................................................................... 49
Procedure and Data Collection ........................................................................................................... 49



Needs Assessment ................................................................................................................................. 50
Curriculum Development .................................................................................................................... 52
Formative Evaluation by Expert Review ........................................................................................... 53
Plan for Data Analysis.......................................................................................................................... 55
Limitations and Delimitations ............................................................................................................. 56
Chapter IV- Results and Findings............................................................................................. 57
Introduction .......................................................................................................................................... 57
Needs Assessment Results .................................................................................................................... 57
Results from the Survey to Decision Makers ..................................................................................... 58
Results from the survey to the End User (MA).................................................................................. 62
Findings ................................................................................................................................................. 66
Comparing Decision Maker and MA Responses ............................................................................... 66
Expert Review Panelists....................................................................................................................... 70
Expert Review Panel ............................................................................................................................ 70
Summary of general recommendations.............................................................................................. 74
Chapter V- Summary of Findings............................................................................................. 75
Introduction .......................................................................................................................................... 75
Major Findings ..................................................................................................................................... 75
Implications........................................................................................................................................... 75
Recommendations for the DSME Curriculum for Medical Assistants ........................................... 76
Implementation..................................................................................................................................... 76
References.................................................................................................................................... 77
APPENDICES............................................................................................................................. 80
Appendix A ........................................................................................................................................ 81
Appendix B ........................................................................................................................................ 83
Appendix C ........................................................................................................................................ 85
Appendix D ........................................................................................................................................ 87
Appendix E......................................................................................................................................... 89
Appendix F......................................................................................................................................... 91
Appendix G ........................................................................................................................................ 93
Appendix H ........................................................................................................................................ 95
Appendix I.......................................................................................................................................... 97
Appendix J ......................................................................................................................................... 99
Appendix K ...................................................................................................................................... 101
Appendix L....................................................................................................................................... 102
Appendix M ..................................................................................................................................... 103
Appendix N ...................................................................................................................................... 113




Figures and Tables
Figure 1 - DSME Outcomes Continuum................................................................................... 33
Figure 2 - Chronic Care Model ................................................................................................. 36
Table 1- Volume of Visits in Primary Care 2007-2008............................................................ 37
Figure 3 - Results from Decision Makers for teachable moments ......................................... 58
Figure 4 - Results from Decision Makers about the best and worst teachable moment ...... 59
Figure 5 - DSME Topics during POV....................................................................................... 60
Figure 6 - Decision Makers Group, Question DSME topics ................................................... 61
Figure 7 - End Users, Teachable moments ............................................................................... 62
Figure 8 - Results from MAs for the Best and Worst Teachable Moments .......................... 63
Figure 9 - Results from MAs for DSMEs to be delivered during POV ................................. 64
Figure 10 - DSME Topics to be delivered during POV........................................................... 65
Figure 11 - Combined Results for Teachable Moments.......................................................... 67
Figure 12 - Combined Results for Best and Worst Teachable Moments .............................. 67
Figure 13 - Combined Results for DSME Topics Delivered during POV ............................. 68
Figure 14 - Comparison of Least and Most Desirable Topics by DMs and MAs, 1 of 2...... 69
Figure 15 - Comparison of Least and Most Desirable Topics by DMs and MAs, 2 of 2...... 69
Table 2 - Decision Makers Group, Question 1 ........................................................................ 87
Table 3 - Decision Makers Group, Question 2 ........................................................................ 87
Table 4 - Decision Makers Group, Question 3 ........................................................................ 87
Table 5 - Decision Makers Group, Question 4 ........................................................................ 88
Table 6 - Decision Makers Group, Question 5 ........................................................................ 88
Table 7 - Decision Makers Group, Question 6 ........................................................................ 88
Table 8 - End Users Group, Question 1 .................................................................................... 89
Table 9 - End Users Group, Question 2 .................................................................................... 89
Table 10 - End Users Group, Question 3 .................................................................................. 89
Table 11 - End Users Group, Question 4 .................................................................................. 90
Table 12 - End Users Group, Question 5 ................................................................................. 90
Table 13 - End Users Group, Question 6 ................................................................................. 90

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