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

Abstract

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 multidisciplinary 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.

Barriers and Facilitators to Workforce Changes in Integrated Care

“…The final selection consisted of 21 studies [383940414243444546474849505152535455565758]. Examples of integrated care interventions included patient education by specialist nurses, structured patient-oriented care coordination, the use of a patient registry to support multidisciplinary team work and practice nurse involvement in shared medical appointments.…”

Training Health Care Professionals for 21st-Century Practice

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Quality Improvement and Patient Safety in the Pediatric Ambulatory Setting: Current Knowledge and Implications for Residency Training

“…[44][45][46][47][48][49][50] All were in ambulatory sites, combining didactic instruction with participation in QI activities. Five of these were integrated into 4-week rotations, and two had regular weekly or biweekly meetings over a year.…”