DEVELOPMENT OF A PHYSICIAN OFFICE VISIT DIABETES EDUCATION CURRICULUM FOR MEDICAL ASSISTANTS AND EVALUATION BY EXPERT REVIEW 公开
Gonzalez, Amparo B (2012)
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
About this Master's Thesis
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