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Development of a Diabetes Care Management Curriculum in a Family Practice Residency Program

机译：在家庭实践住院医师项目中开发糖尿病护理管理课程

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Improving the quality of care for patients with chronic illness has become a high priority. Implementing training programs in disease management (DM) so the next generation of physicians can manage chronic illness more effectively is challenging. Residency training programs have no specific mandate to implement DM training. Additional barriers at the training facility include: 1) lack of a population-based perspective for service delivery; 2) weak support for self-management of illness; 3) incomplete implementation due to physician resistance or inertia; and 4) few incentives to change practices and behaviors. In order to overcome these barriers, training programs must take the initiative to implement DM training that addresses each of these issues. We report the implementation of a chronic illness management curriculum based on the Improving Chronic Illness Care (ICIC) Model. Features of this process included both patient care and learner objectives. These were: development of a multi-disciplinary diabetes DM team; development of a patient registry; development of diabetes teaching clinics in the family practice center (nutrition, general management classes, and one-on-one teaching); development of a group visit model; and training the residents in the elements of the ICIC Model, ie, the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. Barriers to implementing these curricular changes were: the development of a patient registry; buy-in from faculty, residents, clinic leadership, staff, and patients for the chronic care model; the ability to bill for services and maintain clinical productivity; and support from the health system key stakeholders for sustainability. Unique features of each training site will dictate differences in emphasis and structure; however, the core principles of the ICIC Model in enhancing self-management may be generalized to all sites.
机译：提高慢性病患者的护理质量已成为当务之急。实施疾病管理（DM）培训课程，使下一代医师能够更有效地管理慢性病是一项挑战。居住培训计划没有实施DM培训的特定任务。培训机构的其他障碍包括：1）缺乏基于人群的服务提供视角； 2）对疾病自我管理的支持较弱； 3）由于医师的抵制或惯性而无法完全实施； 4）很少有改变行为习惯的动机。为了克服这些障碍，培训计划必须主动实施针对这些问题的DM培训。我们报告了基于改善慢性病护理（ICIC）模型的慢性病管理课程的实施情况。该过程的特征包括患者护理和学习者目标。他们是：建立多学科糖尿病DM团队；开发患者登记册；在家庭实践中心发展糖尿病教学诊所（营养，综合管理课程和一对一教学）；制定小组访问模型；并对居民进行ICIC模型要素的培训，例如社区，卫生系统，自我管理支持，交付系统设计，决策支持和临床信息系统。实施这些课程变更的障碍包括：建立患者登记系统；从教师，居民，诊所领导，员工和患者那里购买慢性病护理模式；收取服务费用并保持临床生产力的能力；以及卫生系统主要利益相关者对可持续性的支持。每个培训站点的独特功能将决定重点和结构的差异；但是，ICIC模型在增强自我管理方面的核心原则可能会推广到所有站点。

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