1. 1 September, 2007
CDMC LINKS Update
September 2007
LEARNING
Contents
CDMC Update 2
INNOVATING
CPR School 2 NETWORKING
Delivery System 2 KNOWING
Design Explained
SHARING
Orientation for new 3
staff members
Facilitating the 4 This series of the CDMC LINKS Update will explain and share
Referral Process information on the Chronic Care Model. This months theme is on
Impact of Group Visits 4 Delivery System Design.
on A1C Delivery System Design
@ HQC 5
Evidence suggests that effective chronic illness management
involves more than simply adding additional interventions to a
Additional Resources 5 current system focused on acute care. It may necessitate
changes to the organization of practice that impact provision of
care.
Links to the Following Change Concepts
♦ Know all your patients who have diabetes and/or CAD
♦ Be systematic and proactive in managing care for people with diabetes and/or CAD
♦ Involve patients with diabetes and/or CAD in delivering and developing care
♦ Develop effective links and communication strategies with key local partners involved in care and
support of people with diabetes and/or CAD
♦ Shape the handling of demand
♦ Match the supply of the practice to the reshaped demand
Please spread the word by forwarding this e-mail to colleagues who might
be interested in this project.
Contact Sinead McGartland to join our LINKS team.
“Once we rid ourselves of traditional thinking we can get on with creating the future.”
- James Bertrand

2. 2 September, 2007
CDMC UPDATE
What does creativity have to do with Quality Improvement? The theme of LW2 was “Thinking Creatively about CDM”. Teams had an
opportunity to brainstorm new ways to manage diabetes and coronary artery disease, and to think of innovative approaches to optimizing
patient flow. For more information on the proceedings, please visit our website at: www.hqc.sk.ca/cdm.
Upcoming plans for LW3: The theme of LW3 will be “Spread and Sustainability”. Which is where we determine our role in continuing to
make improvements in chronic disease management, and determine how we hold the gains we have achieved so far. Please visit our web-
site for more information on Learning Workshop 3—www.hqc.sk.ca/cdm.
CPR SCHOOL
Are you out of breath from running behind all day? Feeling congestion…in your waiting room? Maybe you need some CPR - Clinical
Practice Redesign. What is Clinical Practice Redesign? It's a systematic approach that helps health care providers understand their supply
and demand and make changes that create better office efficiency, increase patient and staff satisfaction, and improve clinical outcomes.
In December 2007, HQC will be offering CPR School. CPR School will provide training and support for people who are interested in
facilitating a practice/department in using CPR. The course will cover topics such as:
•Understanding your current system •Intelligent practice redesign
•Reducing wait times and improving flow •Improving satisfaction and meeting patient/client needs
•Quality improvement methods and techniques
If you are interested in learning more about CPR School, please attend one of our information calls. Times available:
• Wednesday, September 26 at 3:00 pm (CST)
• Thursday, September 27 at 10:00 am (CST)
Each call will last approximately one hour, with time available for questions. To register for a call, please contact Lori Jestin-Knauss,
Administrative Assistant, at (306) 668-8810 ext 102, or by email at ljestinknauss@hqc.sk.ca.
DELIVERY SYSTEM DESIGN EXPLAINED
Effective management of chronic illness requires more than simply adding interventions to an existing system focused on acute care.
Rather, it necessitates basic changes in delivery system design. The delivery of patient care requires not only determining what care is
needed, but clarifying roles and tasks to ensure the patient gets the care; making sure that all the clinicians who take care of a patient have
centralized, up-to-date information about the patient’s status; and making follow-up a part of standard procedure.
These changes require a shift of emphasis to quot;plannedquot; visits instead of acute visits. Meeting these needs often requires innovation in the
scheduling and organization of care, such as group or individual planned visits.
Effective management often requires expansion of staff member roles and responsibilities. These changes include all professionals (e.g.,
nurses, health educators) who have the knowledge and time to carry out the range of tasks required to manage complex chronic conditions.
Staff members also need timely access to key clinical data, enough time to interact with patients, and regular, planned follow-up with
patients.
Key Elements of Delivery System Design:
♦ Define roles and distribute tasks among team members
♦ Use planned interactions to support evidence-based care
♦ Provide clinical case management services for complex patients
♦ Ensure regular follow-up by the care team
♦ Give care that patients understand and that fits with their cultural background
“Once we rid ourselves of traditional thinking we can get on with creating the future.”
- James Bertrand

3. 3 September, 2007
Staff transition—Orientation for new staff
Every new staff member needs an orientation to the way you do business, including elements such as: your practices’ philosophy of
care; logistics of your organization; definitions, and more specifics on what the new person will be doing. Have you thought about
an orientation to the CDM Collaborative for those new staff members?
Orientation to the CDMC:
More information on the CDM Collaborative is available on the HQC website: www.hqc.sk.ca/cdm or by contacting an HQC staff
member, or by connecting with the Collaborative Facilitator in your region.
1.0 What is Quality Improvement (QI): A range of strategies and techniques designed to improve performance and quality in the
health care system.
2.0 What is a Collaborative: A Collaborative is a learn-by-doing approach to quality improvement that relies on the spread and adapta-
tion of existing knowledge to multiple settings to accomplish a common aim.
3.0 Saskatchewan Chronic Disease Management Collaborative: The Collaborative is a partnership that includes all 13 health regions,
73 family physician practices (including office staff), First Nations organizations, and community health care providers, among
others.
CDM Collaborative Topics:
♦ Coronary Artery Disease
♦ Diabetes
♦ Clinical Practice Redesign
CDM Key Measures:
Diabetes:
Patients living with diabetes are well-managed, as evidenced by:
♦75% of patients with A1C ≤ 7.0%
♦75% of patients with blood pressure ≤ 130/80
♦75% of patients with TC/HDL ratio < 4.0
Coronary Artery Disease:
Over the five years, a greater reduction in mortality of patient with CAD. There is an improvement in management of pa-
tients with CAD as evidenced by:
♦75% of patients receiving anti-platelet therapy
♦75% of patients with blood pressure <140/90 or ≤ 130/80 (if patient has diabetes or renal disease)
♦75% of patients with TC/HDL ratio <4.0
Clinical Practice Redesign (ACCESS)
♦ 80% of patients are seen on the day of their choice.
4.0 Chronic Disease Management Toolkit: The CDM Toolkit is an online patient registry to track patient care for people living with
diabetes or CAD, as well as a catalogue of improvement ideas. To date the CDM Toolkit is only available to participants in the
CDM Collaborative, but we do have a demonstrative site for staff members to visit and practice. If this new staff member is going
to participate in your quality improvement efforts, it is recommended to have him/her set up with a Toolkit Account and work with
the Collaborative Facilitator in your region to understand how to use the system.
Available Jones, M.D.
Mounting evidence shows that doctors can see patients quickly —even in perennially backlogged practices—and that
when they do, they benefit themselves and the people they treat. For more information on this article please visit
http://www.slate.com/id/2173271/pagenum/all/#page_start
“Once we rid ourselves of traditional thinking we can get on with creating the future.”
- James Bertrand

4. 4 September, 2007
DIABETES EDUCATION CENTRE FACILITATING THE REFERRAL PROCESS
When Diabetes Education Centre (DEC) personnel visit The Battlefords Primary Health Care sites, the latest copy of the Flow sheet
from the Chronic Disease Management (CDM) Toolkit is given to the educators. By sharing the flow sheet, the DEC is provided with
the latest vital information allowing the educators to focus on the specific needs of the client during the visit.
The benefit of sharing the latest copy of the flow sheet with the DEC is:
◊ The client can see that we are working as a team
◊ Information is up to date
◊ The flow sheet is used to show the client trends in controlling their illness
◊ The information allows teaching opportunities for exploring changes for improvements and/or encouraging continued
monitoring and regimes to ensure good control
◊ DEC can reinforce what the physician is doing or changes that have been recommended.
Outside of the physician clinic setting, the North Battleford DEC suggests the following process when referring clients for
education:
◊ Inform the client of the referral to the DEC
◊ Inform the client of the reasons for referral to the DEC
◊ Inform the client of the process used by the DEC in arranging appointments
In North Battleford, clients are given the opportunity to book an appointment with the diabetes nurse educator and dietitian as well as
attending a basic diabetes class. Clients referred receive a blue book, Diabetes Basics, from the DEC through the mail, providing all
clients with basic information while they are awaiting their appointments. Some clients do not attend education sessions and so this,
booklet provides a current reference about managing their diabetes. This 16 page large print book includes the following subject
areas:
1. What is Diabetes?
2. Blood Sugar Testing and use of Monitors.
3. Healthy Eating is All About…
4. Physical Activity and Diabetes
5. Stepwise Approach to the Treatment of Type 2 Diabetes (medications)
6. Diabetes Foot Care
7. What is a Low Blood Sugar Reaction?
8. Sick Days
IMPACT OF GROUP VISITS ON A1C
The Saskatoon Community Clinic is celebrating a drop in their mean A1C from 7.3% to 7.0% in 18 months - and they have
every reason to be proud of this accomplishment. As a wave 1 participant in the CDM Collaborative, tracking this measure
since March 2006 has allowed the Clinic team to monitor their progress. What factors could account for this improvement?
Clinic physicians and other health care providers think that educators who run the clinic’s diabetes education program
have had a lot to do with it.
Over the past year, Nurse Practitioner Jone Barry and Dietitian Renee Colwell have changed the format of their education
sessions from one-on-one to a small group. The educators think that group dynamics and the use of effective training
tools have facilitated patient self management skills. One particularly valuable education tool is a diabetes conversation
map which prompts patient groups to learn and discuss how to reach their individual goals, in the face of everyday realities
and challenges.
Diabetes education in a group setting has improved both client and provider satisfaction. With this group format, the
educators are seeing changes in their clients’ attitudes and behaviors to a degree that was not achieved through individual
education sessions. Interdisciplinary team members of the Saskatoon Community Clinic believe that by providing clients
with the tools for self-management, returns the control to the client and the understanding that they are a valued director of
their own care.
“Once we rid ourselves of traditional thinking we can get on with creating the future.”
- James Bertrand

5. 5 September, 2007
What’s happening @ HQC?
Adventures in Improving Access
Saskatoon urologist Kishore Visvanathan is blogging about his office's efforts to shorten wait times for appointments. Each week,
Kishore shares stories about the project - the challenges and victories, the obstacles and the quot;aha'squot; - as he and his colleagues
work to drive down their backlog and push up the satisfaction of patients, referring physicians, and their own team. You can locate
Kishore’s blog on HQC website at: www.hqc.sk.ca and click on the “Adventures in Blogging” Icon on the right-hand side.
The Patient-Centred Discharge Modified Collaborative
Modified Collaborative participants had an opportunity to try out the“100 Change Ideas” brainstorming session and generated change
ideas for improving patient flow and communication/education in the discharge process. In less than 30 minutes, teams came up with
70 change ideas.
Interested in more reading on discharge planning:
The August issue of the Saskatchewan Medical Association newsletter includes an article on the Regina discharge planning project. A
few highlights from the article:
♦ The team implemented changes such as using an estimated date of discharge and doing multi-disciplinary rounds.
♦ The gap between the average length of stay and expected length of stay was decreased by nearly 50%.
♦ The reduction translated to 138 bed days saved and 19 more patients treated.
To access the article, please go to the SMA web site: http://www.sma.sk.ca/communications/SMANews/August%202007-web.pdf
Measurement TLQIT
We are still eagerly looking forward to holding the new and improved Measurement TLQIT session on October 18 in Regina. A
gigantic thank you to the Regina Qu’Appelle QI team (Julie Johnson, Jim Scheibel, Brad McDougall, and Sheila Anderson) who
have kindly agreed to lend their excellent facilitation skills/QI experience to the workshop.
Additional Resources
New asthma guidelines balance risk, control
New guidelines unveiled by U.S. federal health experts on Wednesday for tackling asthma carve out a new age group,
children 5 to 11, for unique treatment.
Inhaled corticosteroid drugs remain the best long-term treatment to control asthma in all age groups, according to the Na-
tional Heart, Lung and Blood Institute guidelines. Existing guidelines had called for children 5 to 11 to be treated the
same as adults. The new ones specify three age groups to get different treatment for asthma: birth to 4 years, 5 to 11,
and 12 and older. The middle group was created amid emerging signs they may respond differently to asthma medica-
tions than adults. http://www.reuters.com/article/healthNews/idUSN2933096520070829
Self monitoring of blood glucose in type 2 diabetes: longitudinal qualitative study of patients' perspectives
Elizabeth Peel, lecturer in psychology, Margaret Douglas, consultant in public health medicine, Julia Lawton, senior re-
search fellow.
Clinical uncertainty about the efficacy and role of blood glucose self monitoring in patients with type 2 diabetes is mirrored
in patients' own accounts. Patients tended not to act on their self monitoring results, in part because of a lack of educa-
tion about the appropriate response to readings. Health professionals should be explicit about whether and when such
patients should self monitor and how they should interpret and act upon the results, especially high readings. http://
www.bmj.com/cgi/content/full/bmj.39302.444572.DEv1
“Once we rid ourselves of traditional thinking we can get on with creating the future.”
- James Bertrand

6. 6 September, 2007
If you have any questions, comments, or concerns about the LINKS Update or the Chronic Disease
Management Collaborative, or if you would like to contribute an item to the next LINKS Update,
please contact:
Sinead McGartland
Knowledge Exchange Consultant
Tel: (306) 668-8810 ext 143
Email: smcgartland@hqc.sk.ca
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Upcoming Conferences
11th Annual CDA/CSEM Professional Conference
and Annual Meetings
October 24-27, 2007
http://www.diabetes.ca/section_professionals/conf2007-registration.asp
International Conference on
Chronic Disease Management
October 29th - November 1, 2007
http://www.cdmcalgary.ca/en-ca/index.html
“Once we rid ourselves of traditional thinking we can get on with creating the future.”
- James Bertrand