BUILDING YOUR DIABETES EDUCATION ACCREDITATION PROGRAM

Ask a Question: [email protected] DEAP Main Website Page: www.diabeteseducator.org/accreditation

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How to Properly Use the AADE DEAP Workbook

Dear Diabetes Educator,

Welcome to the Diabetes Education Accreditation Program (DEAP) workbook! This resource will prove invaluable to you as you are putting together your diabetes self-management education (DSME) program, as it will guide you along the way of both setting up your program as well as have it ready for accreditation through the American Association of Diabetes Educators (AADE), the only organization out there solely dedicated to you, the diabetes educator. What you will find inside this workbook is: 

The Crosswalk for the National Standards for Diabetes Self-Management Education and Support explaining each of the standards and how they apply to your program in a practical manner.

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AADE Interpretive guidance to help you meet the requirement for each of the 10 standards.

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A checklist for all the supporting documentation you’ll need when you submit your final application.

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Sample documents for each of the areas that are addressed in the Crosswalk. The samples are meant to help guide you.

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Sample patient chart with key areas highlighted.

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Tips to facilitate your program’s process in getting reimbursed from Medicare and/or private payers

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Other frequently asked questions regarding the AADE DEAP application process

We know how the accreditation process can seem like a daunting endeavor from afar. However, you’ve taken the correct first step simply by picking up this workbook and following along. By ensuring that your DSME program adheres to the guidelines described in this workbook, and of course using the friendly and knowledgeable AADE staff as another resource that is available at your disposal, you will realize just how achievable AADE accreditation can be for your program. Let’s start our journey with some general information regarding AADE DEAP found on the next page, followed by the Crosswalk of the National Standards thereafter. We look forward to working with you! Sincerely,

The DEAP Staff 2

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How do you Become Accredited?   

Adhere to the National Standards for Diabetes Self-Management Education and Support Follow the application process Maintain Compliance

AADE offers a simplified and streamlined application process that meets the highest quality requirements set forth by the Centers for Medicare & Medicaid Services (CMS). Did you know? Every program that receives accreditation or renewal receives a one year complimentary membership to AADE. Providers who can bill Medicare for Diabetes Self-Management Education (DSME):       

RDs Physicians (MD or DO) Physician assistants Nurse Practitioners Clinical Nurse Specialists Hospital and diabetes centers Pharmacies

DSMT Reimbursement Tips The accreditation process through AADE is essential to obtain Medicare reimbursement for DSMT. However, it is a separate process and does not guarantee Medicare payment. In addition to the accreditation process, a DSMT program should do the following:        

Sponsoring organization must have an NPI number as well as be enrolled as a Medicare provider for services other than DSMT NPI application forms: https://nppes.cms.hhs.gov or for paper application, call 800-465-3203 If new to Medicare, need to submit Form 855I to enroll as a Medicare provider (obtain forms through local Medicare Administrative Contractor (MAC) DME/Pharmacy providers must also enroll as a Part B provider to bill for DSMT services Must submit notice of AADE accreditation to local Medicare Administrative Contractor (MAC) Confirm that the HCPCS codes for billing DSMT are loaded in billing system (G0108 and G0109) Submit accreditation notice to contracted commercial payers and verify that DSMT codes G0108 and G0109 are included in contract. If off-site locations are added to accredited program, follow process and recommended steps included on AADE website.

Programs and members of AADE can seek additional information from the AADE “Reimbursement Expert” located in our Member Center: www.diabeteseducator.org

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The National Standards for Diabetes Self-Management Education and Support

To obtain a full copy visit our website: http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/general/2012NationalStandards.p df 5

Crosswalk for AADE’s Diabetes Education Accreditation Program

Full Crosswalk is found at the end of this document

How to use the Crosswalk: The Crosswalk is set up in four columns. It is designed to allow the user to read the definition of a specific standard, review the essential elements and then understand the interpretive guidance provided by AADE for the specific standard. Standards – This is the actual standard found in the National Standards for Diabetes Self-Management Education and Support document, seen on page 3 of this document. Essential Elements - Specify what the program must do to fulfill requirements of each standard. This information is often copied directly from the original document. Essential Elements Checklist – The checklist is numbered 1 – 27. This is a list of the items needed when applying for accreditation. Item 25 has several bullets points for several standards. These are all items that need to be found in the patient’s chart. Interpretative Guidance – This information is developed by the AADE Advisory Committee for DEAP and approved by the Centers of Medicare & Medicaid Services (CMS). It helps the applicant understand the requirement of a particular standards and gives useful tips.

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AADE DEAP Initial Application Supporting Documentation CheckList Standard 1:  DSME/T Organizational Chart including representation of Advisory Group  Program Mission and Goals  Letter of support from your sponsoring organization Standard 2:  Documented plan for seeking outside input from Advisory Group Membership Standard 3:  Documentation identifying your population  Documented allocation of resources to meet population specific needs. (E.g. room, materials, curriculum staff, support etc…)  Identification of and actions taken to overcome access related problems as well as communication about these efforts to stakeholders (document in application) Standard 4:  Program Coordinator Job Description  Program Coordinator Resume reflecting diabetes education experience  Documentation that the Program Coordinator received a minimum of 15 hours of CE credits per year (program management, education, chronic disease care, behavior change) OR credential maintenance (CDE or BC-ADM) Standard 5:  Job Descriptions for all other Diabetes Education staff (instructors, dietician, community health workers)  Current credential for instructor(s) (including licensure and/or registration proof)  Instructor’s resume is current and reflects their diabetes education experience  Proof of Licensure for all other diabetes education staff  Proof of Continuing Education credits related to diabetes for diabetes educators from the past 12 months  There is documentation of successful completion of a standardized training program for CHWs (Training includes scope of practice relative to role in DSME)  Documentation that the CHWs are supervised by the named diabetes educator(s) in the program  Policy that identifies a mechanism for ensuring participant needs are met if needs are outside of instructor’s scope of practice and expertise Standard 6:  One section or outline of your written curriculum demonstrating integration of AADE7 Self-Care Behaviors. If you are using a pre-published curriculum, you need only include a copy of the cover page. Standard 7:  Education Process Policy from referral to follow up  De-Identified Patient Chart of a real patient that went through the DSME/T program from referral to follow up (See record Review to ensure all components are met) Standard 8:  See record review this is incorporated into the de-identified patient chart Standard 9:  See record review this is incorporated into the de-identified patient chart Standard 10:  Evidence of aggregate data collected and used for analysis of both behavioral and clinical outcomes is clearly identified at time of application (Table is in the application or you may submit separately).

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The National Standards for Diabetes SelfManagement Education and Support Review

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Standard 1

Internal Structure: The provider(s) of DSME will document an organizational structure, mission statement, and goals. For those providers working within a larger organization, that organization will recognize and support quality DSME as an integral component of diabetes care. AADE Interpretive Guidance: Standard one relates to your programs formalized internal structure. The Organizational Chart is a graphic or narrative depiction of formal relationships within the Organization that identifies areas of responsibility, accountability relationships and channels of communication. The mission statement is a brief description of the program’s fundamental purpose. It answers the question, “Why do we exist?” This statement broadly describes the program’s present capabilities, customer focus, and activities. The audience is identified in the mission statement. The Goals identify the intended activities needed to accomplish the mission.

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AADE will review the program’s mission statement, goals and letter of support from your sponsoring organization. If your program is small and you are the sponsoring organization please write a statement of support for the DSME program demonstrating the program’s commitment to the people with diabetes in your community. Meeting the Requirements for Standard 1: The Essential Elements that are needed in order to comply with Standard 1 are as follows and are listed on the checklist found on page 6. 1. Clearly documented organizational structure of DSME Program illustrating the clear channels of communication to the program from sponsorship 2. Documentation of program mission 3. Documentation of program goals 4. Letter of support from your sponsoring organization Samples for Standard 1: Internal Structure

Sample Organizational Structure:

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Sample Program Mission Statement: To empower our patients with the self-care management skills necessary to improve their quality of life, using what they have learned through diabetes self-management education at ABC Diabetes Education and Support Program at DEAP Hospital.

Program Goals:     

To impact the lives of our clients through the services and products we provide. To enable the people with diabetes to take charge of their health and healthcare through interactive education, self-management coaching, and support. To improve access for the people with diabetes in the metropolitan and rural areas by adding additional sites in the next 12 months. Provide current evidence based education in an open and conducive environment. To become a medium of healthcare change to the community in which we serve.

Sample Letter of Support:

ABC Diabetes and Wellness, LLC February 26, 2014 ABC Diabetes and Wellness 6204 Middleton Drive Channahon, MI 60440 DEAP American Association of Diabetes Educators To Whom It May Concern: I humbly write to inform you that Diabetes and Wellness Center supports the diabetes self-management program offered by ABC Diabetes and Wellness. This program will be serving patients in surrounding cities especially Channahon and Morris. We strongly look forward to having the diabetes program accredited by the American Association of Diabetes Educators. We know that this will be a great asset to our program, demonstrating high quality and structure. Yours sincerely, John DEAP President Diabetes and Wellness Center

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Standard 2

External Input: The provider(s) of DSME will seek ongoing input from external stakeholders and experts to promote program quality. AADE Interpretive Guidance: Standard two relates to the programs seeking input from key stakeholders and experts in their community. Input can be completed by phone, survey, email or face to face. However, interactions with stakeholders and subsequent follow-up needs to be documented along with the details of the interaction and the content of the discussions including; participating Stakeholders, Program changes, Access issues, CQI action plans, DSMS. Stakeholder Feedback; a program must have an annual report reflecting this input available for review Suggested stakeholders include but are not limited to: people with diabetes, health professionals, and community interest groups A suggested timeline for new programs include: reaching out to stakeholders within the first six months of accreditation, and at the end of the first year this initial 6 month outreach will allow for input early on and will help shape and formalize new programs.

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Meeting the Requirements for Standard 2: The Essential Elements that are needed in order to comply with Standard 2 are as follows and are listed on the checklist found on page 6. The essential elements are numbered throughout the entire document in order to have a single number reflect one item throughout the entire document: 5. Program has a documented plan for seeking outside input 6. The program’s outreach to community stakeholders and the input from these stakeholders must be documented and available for review, annually and periodically as requested Samples for Standard 2: External Input SAMPLE ADVISORY COMMITTEE RESPONSIBILITIES: The purpose of the Committee is to involve health professionals, team members and other applicable disciplines in the planning, review and evaluation of the DSME program. The committee will make recommendations to the DSME Team regarding the development, implementation and evaluation of the program. 1. The advisory committee will meet at least annually and more often as necessary. 2. The committee will meet in person or by phone at a date and time agreed upon by the group. a. Committee may communicate through emails, phone conversations, in person or other electronic means such as Skype. b. Community stakeholders may be surveyed and results shared with the committee c. Minutes will be documented and shared with committee and kept on file for the duration of the accreditation. 3. The committee will review and discuss the following items: a. b. c. d. e. f.

Current program curriculum Individual and aggregate outcomes data collected by the coordinator Annual program plan and evaluation Results of CQI projects Successes and concerns related to any facet of the program Collected and reviewed community in order to meet the needs of the patients in the program g. Discuss recommendations for improvement of the program h. Resolution of access issue for the community to a DSME program. Members of the Advisory Committee: Program Coordinator, At least one instructor, Other health professionals such as; behaviorist, exercise physiologist, pharmacist, provider, podiatrist, referring provider, consumer and other community representatives and other stakeholder(s) such as health professional who are not members of the staff. 13

Sample Advisory Minutes

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Standard 3

Access: The provider(s) of DSME will determine whom to serve, how best to deliver diabetes education to that population, and what resources can provide ongoing support for that population. AADE Interpretive Guidance: Standard three relates to the program’s knowledge and understanding of the population they serve and could potentially serve in their community. Provider must identify and understand their program’s population demographic characteristics, such as ethnic/cultural background, gender, and age, as well as their levels of formal education, literacy, and numeracy. Understanding their population also entails identifying resources outside of the provider’s practice that can assist in the ongoing support of the participant. Allocation of resources must be reviewed, and documented items which are based on assessment of the population’s specific needs including but not limited to: room, materials, curriculum, staffing, support, how classes are structured and when they are offered.

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Meeting the Requirements for Standard 3: The Essential Elements that are needed in order to comply with Standard 3 are as follows and are listed on the checklist found on page 6. 7. Documentation identifying your population is required and is reviewed at least annually 8. Documented allocation of resources to meet population specific needs. (E.g. room, materials, curriculum, staff, support etc…) 9. Identification of and actions taken to overcome access related problems as well as communication about these efforts to stakeholders Samples for Standard 3: Access The Centers for Disease Control and Prevention has useful data to help you view the population in your specific state, city, etc… Please visit this valuable resource. Diabetes Data & Trends: http://apps.nccd.cdc.gov/DDTSTRS/default.aspx Diabetes Public Health Resources: http://www.cdc.gov/diabetes/atlas/ Health Literacy: http://www.cdc.gov/healthliteracy/

Items to consider are as follows but can be submitted in any format: Potential community population: Type of Diabetes, Ethnicity, Age, Unique Characteristic such as but not limited to; literacy, transportation, payers available in the community, uninsured… 16

Items to consider when defining your allocation of resources to meet the needs of the population:       

Staffing Curriculum Equipment Handouts (language, print, literacy….) Interpreter Services Literacy and numeracy materials as appropriate Space (Size, safety, comfort…)

Sample of Program Target population: The population of Channahon, MI is made up of a majority of White, English-speaking citizens. According to the American Community Survey of the United States Census Bureau, Channahon is home to 96.1% Whites. The Center strives to meet the needs of every patient. The Center has several different ways of communicating to those who speak a different language, cannot speak, or who suffer from hearing or seeing impairments. All medical records reflect the preferred language of the patient as well as any communication barriers. Nursing staff is directed to ask each patient whose preferred language is not English whether they require an interpreter for their visit. Upon patient request, Spanish interpreters are available. The Telephone Interpreter Service is used for all other preferred languages. The Center accommodates all hearing and visually impaired patients to the best of their ability. If there is a communication barrier it is noted in the patient’s chart. Staff with the ability to communicate in ASL (American Sign Language) are available as needed to assist the patient. Hearing impaired patients are given written instructions regarding their healthcare plans and medications. The Center will work with patients to get a caption telephone service if needed. Oral instructions are given to all visually impaired patients, then patients are asked to verbally acknowledge to the medical staff their understanding of these instructions. The Center is faced with patients who are un-insured, low income, or are on Medicaid or Medicare. Their goal is to help patients and families, they strive at building a healthy community. The office will provide free diabetic training services based upon the needs of the client. In turn, this free training service will promote controllable blood glucose outcomes as well as give the patients knowledge about nutrition and body changes due to diabetes. The Center will also hand out free blood glucose meters to promote self-management skills and to help improve blood sugar levels. Free blood glucose meters will save the patient from having to come up with the money to purchase one on their own. The meters will be affordable and the patient can get them the day they are diagnosed with diabetes. Most importantly, dedicated trained staff members are located right in the clinic where they provide continuity care among patients. Trained staff members make it easier for the patients to talk to them. Also, patient are more apt to come in or call if they have any questions or concerns. The Center encourages immediate action and support along the way.

Items to consider when identifying actions to overcome access related problems:   

No other program within XX amount of miles Additional sites added Discussion at advisory meeting to get stakeholder input

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Sample of Program Identified Resources: Resources needed for the Diabetes and Wellness Center are already accessible. The Center has an education room that will facilitate 3-4 people. This room will be utilized for 1:1 education. It is handicapped accessible with wheelchairs provided as needed. Education materials have been acquired and are readily available in English and Spanish. In the current facility there is also a large meeting room in the front lobby. Group education classes will be held in there. Video equipment, projector, and computer systems are available for PowerPoint presentations. Translators will be available as needed for group education classes in both English and Spanish. Visual learning aids and models are available for patients as well as written materials in both English and Spanish.

Standard 4

Program Coordination: A coordinator will be designated to oversee the DSME program. The coordinator will have oversight responsibility for planning, implementation, and evaluation of education services.

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AADE Interpretive Guidance: Standard four focuses on the leadership of the program through the program coordinator. The breadth and depth of responsibilities of the program coordinator will vary with the program size and complexity, but, at a minimum, the coordinator must have the ability to be responsible for planning, implementation and evaluation of services. The program coordinator must have skills and experience of working with managing a chronic disease, facilitating behavior change, in addition to experience with program and/or clinical management. The program coordinator must complete 15 hours of continuing education on an annual basis as it relates to diabetes care as well as their profession i.e. program management, education, chronic disease care, behavior change. {If the program Coordinator is a CDE or BC-ADM they do not need the 15 hours in the year prior to accreditation but must attest to receiving these hours on an annual basis, moving forward after accreditation.} Meeting the Requirements for Standard 4: The Essential Elements that are needed in order to comply with Standard 4 are as follows and are listed on the checklist found on page 6. 10. Coordinator’s resume (reflecting experience managing a chronic disease, facilitating behavior change, and experience with program and/or clinical management): 11. Job description describing program oversight (must include planning, implementation and evaluation of the DSMT program): 12. Documentation that the Program Coordinator received a minimum of 15 hours of CE credits per year (program management, education, chronic disease care, behavior change) OR credential maintenance (CDE or BC-ADM)

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Sample Resume:

Ms. Program Coordinator, RN., BSN., BC-ADM 200 W. Madison Chicago, Il 60606 Phone: 222-555-5555 E-mail: [email protected] Education:     

Master’s Degree of Science in Nursing - Lewis University - 2000 Board Certified – Advanced Diabetes Management – 2009 Bachelors Degree of Science in Nursing- University of NE Med Center Associate Degree of Applied Science- Joliet Jr. Community College Minooka Community High School – Channahon, Michigan

Experience: January 2011- present The Medical Center of Channahon  Program Coordinator/Instructor-BC-ADM  Teaching pre-diabetes, Type 1, Type 2, Gestational diabetes, Intensive Management  Working in collaboration with 7 Family Practice physicians and 3 PAs to improve their patient’s diabetes care and outcomes.  Responsible for the planning, implementation, and evaluation of the DSME program.  Actively involved in developing behavioral goals collaboratively with patients and their families.  Staff liaison to the Advisory Committee  Management and oversight to all Community Health Workers in the DSME program March 2008-January 2011 ABC Medical Health  Clinical Program Coordinator for Diabetes Program.  Developed teaching program for uninsured/underinsured patients with diabetes.  Educated patients at all knowledge levels on diabetes survival skills.  Managed patient’s blood glucose in combination with physician orders.  Worked with different insulin protocols to achieve improved glucose control.

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Sample Job Description:

Diabetes Self-Management Education Program Coordinator JOB DESCRIPTION

POSITION:

DSME Program Coordinator

SUPERVISES: Program Staff RESPONSIBILITY:       

Responsible for planning, implementation, and evaluation of education services. Oversees the staff involved with the Diabetes Education Program. Coordinates quality assessment reviews of the program at least annually to ensure that PCHS is meeting the program goals. Presents the annual data a monthly provider meeting for continuous quality improvement input by providers and staff. Develops and maintains relationships with community groups who could provide referral services. Facilitates the Advisory Committee Complete 15 hours of continuing education on an annual basis as it relates to diabetes, program management, education, chronic disease care, behavior change.

KNOWLEDGE, SKILLS AND ABILITIES:    

Knowledge about chronic disease management and disease self-management educational processes Supervisory abilities Proficient in various computer applications, including spreadsheets Marketing skills

EXPERIENCE/EDUCATION:   

Experience or education in facilitating behavior change Experience with program and/or clinical management Education in, and/or experience with, chronic diseases and disease self-management 21

Sample Statement of Credit: Other similar documents can be used.

Title of Course must be Included

Must have your name and the amount of CE credit

Standard 5

The program coordinator must complete 15 hours of continuing education on an annual basis as it relates to diabetes care as well as their profession i.e. program management, education, chronic disease care, behavior change. {If the program Coordinator is a CDE or BCADM they do not need the 15 hours in the year prior to accreditation but must attest to receiving these hours on an annual basis, moving forward after accreditation.} 22

Standard 5 has two pages. The actual Crosswalk is at the end of this document. Instructional Staff: One or more instructors will provide DSME and, when applicable, DSMS. At least one of the instructors responsible for designing and planning DSME and DSMS will be an RN, RD or pharmacist with training and experience pertinent to DSME, or another professional with certification in diabetes care and education, such as a CDE or BC-ADM. Other health workers can contribute to DSME and provide DSMS with appropriate training in diabetes with supervision and support. AADE Interpretive Guidance: Standard five focuses on meeting the needs of the population the program serves through qualified instructional staff and outside referrals as needed. Expert consensus supports the need for specialized diabetes and educational training beyond academic preparation for the primary instructors on the diabetes team A number of studies have endorsed a multi-disciplinary team approach to diabetes care, education, and support, reflecting the evolving health care environment. Continuing education for instructional staff needs to be diabetes-specific, diabetes-related, and/or behavior change self- management education strategies-specific (e.g., AADE7 self-care behaviors)

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Lay health, community workers and peer counselors or educators may contribute to the provision of DSME instruction and provide DSMS if there is documentation of their having received training in diabetes self-management, the teaching of self-management skills, group facilitation, and emotional support. The annually reviewed and updated documentation of appropriate training needs to be signed by the program coordinator. This documentation must be available for review and because this level staff may not qualify for Continuing Education. Documentation can be a certificate of completion or a competency checklist. CHW must receive training on an annual basis specific to their role. A system is in place that ensures supervision of the services the CHW provides. The nature of this supervision by a named diabetes educator or other health care professional and professional back-up to address clinical problems or questions beyond their training must be documented. This supervision can be in person, by phone using a protocol for suggesting follow-up with the diabetes educator or other health care professional. Mechanisms for meeting needs outside a scope of practice includes: referrals to other practitioner and/or partnering with a professional with additional expertise (e.g., exercise physiologist or behavioral specialist) and is clearly documented. Meeting the Requirements for Standard 5: The Essential Elements that are needed in order to comply with Standard 5 are as follows and are listed on the checklist found on page 6. 13. Document that at least one of the instructors is an RN, RD or pharmacist with training and experience pertinent to DSME, or another professional with certification in diabetes care and education, such as a CDE or BC-ADM 14. Current credential for instructor(s) (including licensure and/or registration proof) 15. Instructor’s resume is current and reflects their diabetes education experience 16. 15 hours of CE credits per year for all instructors annually 17. There is documentation of successful completion of a standardized training program for CHWs (Training includes scope of practice relative to role in DSME): 18. Documentation that the CHWs are supervised by the named diabetes educator(s) in the program 19. Policy that identifies a mechanism for ensuring participant needs are met if needs are outside of instructor’s scope of practice and expertise

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Sample of proof of licensure/registration:

Number Name and Address

#1 Mistake Make sure you are not expired

Name

Number

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Community Health Workers (CHW)

Community Health Workers—also known as community health advocates, lay health advisors, lay health educators, community health representatives, tribal diabetes educators, peer health promoters, community health outreach workers, and promotores de salud—are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served. By definition, a community health worker is a member of the community they serve, and thus are uniquely skilled to serve as bridges between community members and healthcare services because they:    

live in the communities in which they work, understand how to translate “medical talk” to community members, explain the community perspective to providers communicate in the language of the people in their communities

CHWs understand the cultural buffers, such as cultural identity, spiritual coping, and traditional health practices that can help community members cope with stress and promote positive health outcomes. A critical asset of programs that engage CHWs is that they build on already existing community network ties that contribute to the acceptance and sustainability of effective community programs. If CHWs are part of your program’s team, there needs to be documentation that they are directly supervised by, the named diabetes educator(s) in the program. When a Community Health Workers (CHW) is a part of the DSMT team, there needs to be documentation of successful completion of a standardized training program for CHWs and additional and on-going training related to diabetes self-management. Training includes scope of practice relative to role in DSMT. AADE has several available training tools on its website: 

Fundamentals of Diabetes Care - a self-paced, 6-module online program that focuses on training medical assistants, licensed practical nurses, and other healthcare technicians to deliver appropriate level diabetes care to patients within their practice setting. Technicians who complete the program will be better prepared to assist patients with diabetes and refer them to DSME.

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ABCs of Diabetes Education - a self-paced, 6-module online course that focuses on the essential knowledge and skills needed by non-diabetes educator clinicians who want to enhance their ability to work with patients with diabetes. Nurses, dietitians, and pharmacists should consider this interactive course as one of the first steps towards becoming a diabetes educator.

Above programs can be found at: https://nf01.diabeteseducator.org/eweb/DynamicPage.aspx?Site=AADE&WebCode=OnlineCourse&p ager=10

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Sample Job Description:

Title: Community Health Worker Reports To: DSME/T Program Coordinator/ Director and Instructors Position Overview: Responsible for helping patients and their families to navigate and access community services, other resources, and adopt healthy behaviors. The CHW supports the program coordinator and instructors through an integrated approach to care management and community outreach. Duties and Responsibilities: 

     

Basic Assessment - Measure vital signs and anthropometrics, assess literacy, and follow protocols for patient intake. Assessment may include family and social support systems. Provide support, general information, and guidance regarding accessing care, available diabetes education offerings, and financial assistance. Goal Setting - May help patients by providing basic information and assisting in setting basic goals for healthy eating and physical activity defined by protocols. Planning - Follow the prescriber’s orders and diabetes educator’s guidance for planning. Implementation - Refer/support diabetes management skill training, and offer guidance on accessing care and financial resources. Lead support groups or organize a community physical activity (e.g., walking group) . Refer to the prescriber or diabetes educator as needed. Monitor progress toward the plan and report findings to the prescriber and diabetes educator.

Knowledge, Skills and Abilities:    

Friendly, professional and approachable patient care Basic computer skills, including but not limited to, the use of internet and email Collaborate with individuals Preferably speak two or more languages

Education/ Experience:  

Certification or basic, non-clinical degree as a community health worker Standardized training (ABCs of Diabetes Education, Fundamentals of Diabetes Care…)

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Sample Policy for – A mechanism for ensuring participant needs are met if needs are outside of instructor’s scope of practice and expertise Subject: Outpatient Diabetes Referral Process Policy: Standard procedures guide outpatient diabetes referrals to ensure that licensed professionals are meeting participant’s needs. Procedure: 1. The Clinical Dietician/CDE will document outpatient initial nutrition counseling session using the standard intake form. 2. If during this initial session it is determined that the individual needs additional counseling outside the profession or ability of the Clinical Dietician/CDE an appropriate referral will be made. 3. The individual may be referred to a host of licensed professionals available throughout the community (referring provider will be notified). 

The following list of professionals are not all inclusive: o o o

Exercise Physiologist through Somewhere Hospital, Licensed Professional Counselors working with Counselors R Us, Wound Care Department at Somewhere Hospital, Outpatient Cardiac Rehab Team, Vision Eye Associates, etc….

4. If emergency assistance is needed 911 will be called and the referring provider will be notified. 5. Referring provider may be notified for referral. 6. A copy of the individual’s counseling record will be forwarded to the referring physician’s office. Recommendations for additional counseling would be included in this documentation.

This policy is especially important in a single discipline program.

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Standard 6

Curriculum: Written curriculum reflecting current evidence and practice guidelines, with criteria for evaluating outcomes, will serve as the framework for the provision of DSME. The needs of the individual participant will determine which parts of the curriculum will be provided to that individual. AADE Interpretive Guidance: Standard six specifies curriculum teaching strategies utilized. Programs using a purchased curriculum must describe how the curriculum has been adapted to meet the needs of the population served. While the content areas listed in the essential elements provide a solid outline for a diabetes education and support curriculum, it is crucial that the content be tailored to match each individual’s needs. This includes adaptation as necessary for the following: Assessed need, age and type of diabetes (including prediabetes and diabetes in pregnancy), cultural factors, health literacy and numeracy, comorbidities, and learning style preferences. The content areas must also be adapted and modified to fit the program’s practice setting. Creative, patient-centered, experience-based delivery methods—beyond the mere acquisition of knowledge—are effective for supporting informed decision-making and meaningful behavior change and addressing psychosocial concerns. Approaches to education that are interactive and patientcentered have been shown to be effective. 29

Meeting the Requirements for Standard 6: The Essential Elements that are needed in order to comply with Standard 6 are as follows and are listed on the checklist found on page 6. 20. Evidence of a written curriculum, tailored to meet the needs of the target population, is submitted and includes all content areas listed in the essential elements 21. The curriculum adopts principles of AADE7™ behaviors 22. The curriculum is reviewed at least annually and updated as appropriate to reflect current evidence, practice guidelines and its cultural appropriateness 23. Curriculum reflects maximum use of interactive training methods Sample 1: Evidence of a Written Curriculum:

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Sample 2: Other curriculum available

No matter which curriculum is chosen, it is the programs’ responsibility to make sure information is kept up to date. Curriculum must be reviewed at least annually. These are only a few samples…

Sample 3: Other curriculum available:

Be creative with how you teach your chosen curriculum. You must be interactive and get your patients involved.

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There are other appropriate curricula available. It is important to note that you do need to have a curriculum and you must show evidence of this curriculum at time of application. Your curriculum must have the following components included:        

Incorporating nutritional management into lifestyle Incorporating physical activity into lifestyle Using medication(s) safely and for maximum therapeutic effectiveness Monitoring blood glucose and other parameters, and interpreting and using the results for self-management decision making Preventing, detecting, and treating acute complications Preventing, detecting, and treating chronic complications Developing personal strategies to address psychosocial issues and concerns. Developing personal strategies to promote health and behavior change.

AADE does have free handouts available to download on our website for each one of the AADE7 ™ Selfcare behaviors. These handouts may be used to supplement your program but are not a curriculum. The handouts are available in both English and Spanish. http://www.diabeteseducator.org/DiabetesEducation/Patient_Resources/AADE7_PatientHandouts.html Sample of Handout: The AADE7™ Self-Care Behaviors must be incorporated in to your curriculum. These handouts are useful tools and are free to download. They are not a requirement.

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Sample of Handouts in Spanish:

As stated in the National Standards for Diabetes Self-Management Education and Support, Standard 6; “Approaches to education that are interactive and patient centered have been shown to be effective. Also crucial is the development of action-oriented behavioral goals and objectives.12-14,113 Creative, patient-centered, experience-based delivery methods—beyond the mere acquisition of knowledge—are effective for supporting informed decision making and meaningful behavior change and addressing psychosocial concerns.”

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Standard 7

Standard 7 has two pages. The actual Crosswalk is at the end of this document. Individualization: The diabetes self-management, education, and support needs of each participant will be assessed by one or more instructors. The participant and instructor(s) will then together develop an individualized education and support plan focused on behavior change. AADE Interpretive Guidance: Standard seven focuses on ensuring that the education provided is individualized to each participant. The instructor will assess each participant in order to individualize the best educational and behavioral intervention and support strategies.

This assessment can be done individually or in group. It may include a self-assessment completed by the individual prior to the first meeting. This process should be appropriate for the population the program serves as well as being tailored to meet the needs of any individual participant.

There needs to be a complete, individualized education plan for each participant that includes interventions and desired outcomes. The education plan needs to be developed collaboratively with the 34

participant and family or others involved with the participants care as required. This will guide the process of working with the participant and must be documented in the education records.

Programs also need to document an individualized follow-up support plan. A variety of assessment modalities include: telephone follow-up and use of other information technologies (e.g., Web-based, text-messaging, or automated phone calls), and may be used to augment face-to-face follow-up progress assessments. Meeting the Requirements for Standard 7: The Essential Elements that are needed in order to comply with Standard 7 are as follows and are listed on the checklist found on page 6. 24. The education process is defined as an interactive, collaborative process which assesses, implements and evaluates the educational intervention to meet the needs of the individual 25. De-identified patient chart must include evidence of the following elements 

 

Collaborative participant initial assessment includes minimally: o Medical history, age, cultural influences, health beliefs and attitudes, diabetes knowledge, diabetes self-management skills and behaviors, emotional response to diabetes, readiness to learn, literacy level (encompassing health literacy and numeracy), physical limitations, family support, and financial status Individualized educational plan of care based on assessment and behavioral goal Documented individualized follow-up on education and goals

Sample Education Process Policy:

There are multiple ways to implement your education program. The right way is based on your population needs and resources available. The following example is from a recent program accredited with AADE. Programs tweak this process as needed.

The Center Diabetes Education Program will systematically individualize the diabetes education of its participants through assessment, educational planning, and collaboratively forming health goals for the participant. Procedure: 1) Referral from provider is entered in the Electronic Medical Record. 2) Patient intake form is sent electronically or mailed to participants to be completed before arriving at class. Returning the intake form (either electronic completion or return via mail) before the scheduled class will be highly encouraged. Participants will be told to arrive 15 min early so that the instructor can review any forms received the day of class before instruction commences. 35

3) Patient attends class or individual session with diabetes educator (they may bring a support person to the appointment). Goal setting is completed prior to the end of the session. 4) The assessment, education plan, intervention, and outcomes documentation is completed in the Electronic Medical Record and forwarded to the referring provider. Frequently asked questions about the patient de-identified chart are as follows: What is a "de-identified" chart? Any information in the medical record that may be linked to an individual must be removed before submitting your de-identified chart with your application materials. The privacy standards that are part of the Health Insurance Portability and Accountability Act (HIPPA) require protection of "individually identifiable" health information. Removing any unique identifying number, characteristics, or codes from the participant chart you submit protects you from any HIPPA violation. Examples of the type of information that must be removed are: o o o o o o o o o o

Name Geographic subdivision smaller than a state (street address, city, precinct, zip code) Telephone or fax numbers E-mails Social Security number Medical record number Health plan beneficiary number Account number Date of Birth Never submit any patient over the age of 89

Why it is necessary to submit a patient chart and what parts do I need to include? Reviewing documentation about the care that was actually provided is a significant part of the accreditation review process and it is used for most accreditation and/or certification processes. How do I "de-identify" the patient's information? Using black permanent marker is usually sufficient to effectively hide any data that identifies the patient/participant. Some people have found that using a combination of blue and black markers does a better job of concealing. You could also use "White-Out" or a strip of correction tape. If you have an electronic health record and are submitting materials electronically, you could delete the necessary information after you have saved it to the format for e-mailing.

How do I submit the patient record if I use an electronic health record? Follow these steps in order to submit an electronic health record 36

    

Obtain a "screen shot" of the components of the record needed Save the components identified above in a format that can be e-mailed De-identify the screen shot version of the electronic health record Save the de-identified version to be sent to AADE DEAP Fax, mail, upload into the AADE7 online application or e-mail as an attachment to [email protected]  If the electronic health record does not include the actual assessment questions, (e.g., only the "answers"), submit a template of the assessment form so the reviewer can determine that the assessment process included the necessary elements (see the "Essential Elements" for Standard 7 in the "National Standards, Essential Elements and Interpretive Guidance" document on the DEAP website). Helpful tool found on AADE’s Website. What needs to be included in the de-identified patient chart? http://www.diabeteseducator.org/ ProfessionalResources/accred/Appli Education record review used by AADE and auditors: cation.html

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Sample Initial Assessment

Diabetes Self-Management Training Intake Form SECTION 1: PATIENT INFORMATION Last Name

First Name Gender

Middle

 Male  Female

Date of Birth Address

City

State

Home Phone

Cell Phone

Other Phone

Primary Language

Zip Code

Ethnicity

Referral Source Patient Currently Hospitalized?

 Yes

 No If yes, please specify:

SECTION 2: EMERGENCY CONTACT INFORMATION Last Name

First Name

Phone Number

Middle Relationship

SECTION 3: BILLING INFORMATION Primary Insurance

Policy #

Referring Physician

Phone

Address Prior Diabetic Education:

City

Medicaid Number Fax State

Zip Code

 Yes

 No If yes, please specify:

SECTION 4: FAMILY ENVIRONMENT AND SUPPORT

2. 3.

 Yes  No If no, how many people live with you? Who is your primary caregiver? Do you prepare your own meals?  Yes

4. 5.

If no, who does? Do you have support from family or others to deal with your diabetes? Other psychosocial factors impacting diabetes management:

1.

Do you live alone?

 No  Yes

 No

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Diabetes Self-Management Training Intake Form SECTION 5: MEDICAL INFORMATION Type of Diabetes:

Age:

Exam Results: HgbA1C:

Height:

Weight:

Date:

Annual Foot Exam:

Fasting BG:

Date:

Annual Eye Exam:

LDL-C:

Date:

1.

Are you currently taking oral medications for diabetes?

2.

Have you ever taken oral medications to treat your diabetes? Are you currently taking insulin to control your diabetes?

3.

Have you ever insulin to control your diabetes? Have you taken any steroids like prednisone which impacted your diabetes?

 Yes  Yes

 No  No

    

    

Yes Yes Yes Yes Yes

No No No No No

How did it impact your diabetes? 4.

How often do you measure your blood sugar? What is your usual blood sugar level range?

5.

How often are you physically active (ex: walking, exercising)? Name examples of physical activity:

6.

Do you follow a meal plan?

7.

Do you currently smoke?

 Yes

 No

 Yes

 No

 Yes

 No

 Yes  Yes  Yes

 No  No  No

If yes, what is your meal plan? If yes, what do you smoke? How often? If no, when did you stop? 8.

Do you currently drink alcohol? If yes, how much and how often?

9.

Do you have high blood pressure?

Are you on any medications? 10. Do you have pain from your diabetes? If no, origin of pain: Briefly describe pain:

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Diabetes Self-Management Training Intake Form SECTION 6: CULTURAL FACTORS 1.

Is there anything specific to your culture that you think influences your ability to manage your diabetes?

2.

Do your cultural beliefs influence your ability to manage your diabetes?

3.

Are there certain types of foods important to your culture?

4.

Does having diabetes or having a serious illness create culture stress?

5.

Are there any religious or cultural factors that affect how you eat?

6.

How do you feel about having diabetes (ex: okay, anxious, depressed, and overwhelmed)?

7. Other cultural factors that impact the management of diabetes?

SECTION 7: INDIVIDUAL EDUCATIONAL PLAN 1.

Would you like help with any of the following things (check all that apply)? Increase blood sugar monitoring Manage my depression Understanding my diabetes

Giving myself injections at correctly

Increase my exercise/ physical activity

Communicate better with my doctor

Eating healthier/ Following meal plan

Treat complications from diabetes

Set achievable weight lost goal

(such as foot pain, low vision & energy)

Increase support from family or friends 2.

Identify top three problems you struggle with your diabetes.

3.

Identify barriers to managing your diabetes successfully.

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Diabetes Self-Management Training Intake Form SECTION 8: MEDICATION LIST Medication & Dose

Direction

Doctor

INDIVIDUAL PROBLEMS/ NEEDS/ GOALS: Participant’s readiness for change:

 Action

 Preparation

 Contemplative

 Pre-Contemplative

 Maintenance

 Relapse

Participant’s initial goals:

ACCOMMODATION FOR PARTICIPANT’S INDIVIDUAL EDUCATION NEEDS: Visual, Learning, Mobility, Other disability that needs an accommodations: Summary of Plan:

DSME/T Staff Signature:

Date:

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Sample Patient Chart

42

Referral is a Medicare Requirement for Reimbursement

Free referral found on AADE’s Website. http://www.diabeteseducator.org/ex port/sites/aade/_resources/pdf/gener al/Diabetes_Services_Order_Form_v4. pdf

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Present Health Status

Cultural

Financial can be furthered assessed through insurance verification checks

Support Systems

Educational Learning

Emotional Response

Support Systems

44

Present Health Status

Diabetes SelfManagement Skills and Behaviors

Relevant Medical History

45

Present Health Status

Risk Factors

Current Health Service or resource Utilization

46

Questions some programs ask for Readiness to Learn and Cultural influences Educational Learning

Cultural Influences

Readiness to Learn

47

48

Health Behaviors and Goals

Collaborative Patient Assessment

49

Diabetes Knowledge

50

51

Documented clinical outcome measure

52

Individualized Educational plan of care

53

54

55

Individualized Educational plan of care based on assessment and behavioral goals

56

Documented individualized follow-up

57

Documented individualized follow-up

Follow-up on behavioral goal

58

Documented individualized follow-up

59

60

On-going SelfManagement Support

61

Communication with healthcare team

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Standard 8

Ongoing Support: The participant and instructor(s) will together develop a personalized follow-up plan for ongoing selfmanagement support. The participant’s outcomes, goal, the plan for ongoing self-management support will be communicated to other members of the healthcare team. AADE Interpretive Guidance: Standard eight focuses on the importance of ongoing support above and beyond the initial DSME. While DSME is necessary and effective, it does not in itself guarantee a lifetime of effective diabetes self-care. Initial improvements in participants’ metabolic and other outcomes have been found to diminish after approximately 6 months. DSMS (Diabetes Self-Management Support) is defined as: Activities that assist the person with prediabetes or diabetes in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis beyond or outside of formal self-management training. The type of support provided can be behavioral, educational, psychosocial, or clinical.

63

Programs need to identify community opportunities/resources that may benefit their participants and support their commitment to their chosen behavioral modifications. The options available need to be offered with the patient’s preferences documented. Community programs need to be reviewed periodically to insure that participants are provided with current information. The community programs can also provide external input to meet elements in Standard two.

Meeting the Requirements for Standard 8: The Essential Elements that are needed in order to comply with Standard 8 are as follows and are listed on the checklist found on page 6. De-identified Chart must also include the following: (As seen in the above patient chart)  

On-going Self-Management Support options reviewed with the Participant Communication to the health care team includes participant’s plan for ongoing support

Standard 9

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Patient Progress: The provider(s) of DSME and DSMS will monitor whether participants are achieving their personal diabetes self-management goals and other outcome(s) as a way to evaluate the effectiveness of the educational intervention(s), using appropriate measurement techniques. AADE Interpretive Guidance: Standard nine focuses on establishing individualized clinical outcomes and behavioral goals All goals, including behavioral goals, must be: SMART- Specific, Measureable, Achievable, Reasonable, and Timely. In addition, these behavior goals must relate to the AADE7™ (Healthy Eating, Being Active, Monitoring, Taking Medication, Problem Solving, Healthy Coping and Reducing Risks). Patients do not need to work on all seven behavioral goals at once. Most patients will select one or two initial goals. Clinical outcome measurements need to be chosen based on the population served, organizational practices and availability of the outcome data. Examples include but are not limited to: A1c, weight, B/P, BMI, waist circumference, lipids etc… The participant medical record must reflect assessment of the individual participant’s achievement of goals including any review and / or adjustments made to the educational plan or goals. Meeting the Requirements for Standard 9: The Essential Elements that are needed in order to comply with Standard 9 are as follows and are listed on the checklist found on page 6. De-identified Chart must also include the following: (As seen in the above patient chart)  

Collaborative development of behavioral goals with interventions provided and outcomes evaluated Documentation and assessment of at least one clinical outcome measure

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Sample Worksheet:

66

More Examples of Collaborative Goal Development and Follow-up

67

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Standard 10

Quality Improvement: The provider(s) of DSME will measure the effectiveness of the education and support and look for ways to improve any identified gaps in services or service quality, using a systematic review of process and outcome data. AADE Interpretive Guidance: Standard ten relates to the annual process by which programs will assess their operations, including the delivery of education and support. Programs must have a process/system in place in order to collect, aggregate and analyze clinical outcomes measures and behavioral goal achievement. Evidence of this process with data will need to be submitted at time of application and annually. Continuous Quality Improvement (CQI) insures program engagement, intentional and systematic service improvement with intention of increasing positive outcomes. CQI is a cyclical, data-driven process which is proactive, not reactive. Data for the CQI plan is collected and used to makes positive changes—even when things are going well—rather than waiting for something to go wrong and then fixing it. 69

All DSMT sites, including new entities by the six month mark, must be able to show implementation of the CQI plan. A program may be randomly selected within the first year of accreditation to submit their CQI plan. Examples include but are not limited to: wait times, program attrition, referrals, reduction in A1Cs, education process, weights, foot and eye exams, reimbursement issues, number of referrals, follow up, etc. Meeting the Requirements for Standard 10: The Essential Elements that are needed in order to comply with Standard 10 are as follows and are listed on the checklist found on page 6.. 26. Evidence of aggregate data collected and used for analysis of both behavioral and clinical outcomes is clearly identified at time of application 27. Annual report documenting the ongoing CQI activities following initial accreditation

AADE7 Category

Number of Patients Who Chose this Goal

Number of Patients who Chose this Goal and Completed your Program According to your policy**

Number of Patients Who Reported Success with this goal and Completed your Program According to your Policy**

Healthy Eating Being Active Monitoring Taking Medication Problem Solving Reducing Risks Healthy Coping Clinical Outcome

Percentage of Patients who Reported Success with this Goal and Completed your Program According to your Policy**

Benchmark Percentage of Patient Goal Achievement

(column3/column2)

Evidence of aggregated data collected

Average Baseline Before DSMT

Average after Completion of DSMT Education and Follow-Up

Comments if applicable

A1C B/P BMI Other (specify)

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Sample CQI Plan Identified Problem: Patients with Type 2 diabetes who are referred to our DSME Program do not always have a recent HgbA1c. PLAN: Improve the percentage of patients referred who have a current (within the past 3 months) HgbA1c. DO: Each patient enrolled in classes or individual track will be entered into the AADE7 software program (This is not a requirement). At the end of each quarter, a report will be compiled of the percentage of patients enrolled last quarter who have recent HgbA1c values on enrollment. Identify barriers to drawing and reporting HgbA1c values by discussion with referring offices. Initiate a plan to increase the percentage of patients who are referred with a recent HgbA1c. STUDY: Monitor percentage of patients who are referred with a recent HgbA1c every quarter. Analyze the effect of the plan to increase the percentage of patients who are referred with a recent HgbA1c. Utilize spreadsheet to track data. ACT: Use strategies that are effective and create new ones as needed. Report results to Quality and Risk Management, and the advisory committee annually. Repeat cycle.

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Other Resources

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AADE7™ System

The AADE7™ System, which is referenced in this workbook, is an online patient-tracking system that allows diabetes educators to input and run reports on the patient data they enter. AADE is committed to enhancing your ability to help patients with diabetes identify barriers, facilitate problem-solving, and develop skills to live healthier, more productive lives. The AADE7™ System allows you to:       

Collect and track your patients’ behavior change goals, clinical indicators, and medications Administer online patient self-assessments and follow-ups Track information about the educational services you provide Generate reports on individual patient progress and your facility’s progress Manage classes and group education sessions Create auto-populated, time-saving letters for referring physicians and patients Gather data about your facility that is need for your program accreditation

The AADE7™ System includes the following modules:   

Patient Profile, including demographics, payer information, referring provider, and more Health Status, tracking learning variables, health assessments, and allergies Goal Setting, helping you monitor the specific behaviors your patients would like to change, their progress, and intervention strategies used  Clinical data, including A1c values, lipid profiles, blood pressure levels, anthropomorphic data, and more  Medications, which runs against a frequently updated federal drug database, tracking a patient’s medications, as well as their strength and frequency  Education, which tracks information about the 1:1 and group activities and topics covered  Patient Self-Assessment, an online tool that tracks information such as the patient’s health history, health status, risk factors, diabetes-related lifestyle issues, and more  Classes, allowing educators to easily track attendance and educational topics covered during group sessions  Communication Tools, used to create customizable letters to patients and physicians  Reporting o Static reports on individual patient progress, aggregate outcomes, and site statistics o Ad hoc, dynamic reporting engine allows staff to create custom reports on their selected data points and export data into Excel, CSV, and XML formats for further data analysis o National aggregate reporting allows AADE to monitor and track trends over time The following is a demo site of the Enhanced package that includes fictitious data. Please feel free to add further fictitious data to the site to see how the system functions. Website: Username:

http://educator.aade7.com [email protected] 73

Password: impact1 If you assign patients to complete a self-assessment or follow-up assessments, the patient would receive an automatically generated email with a link to the patient site, along with their login information: Website: http://patient.aade7.com To assign a patient self-assessment, go to http://educator.aade7.com. You need to create a patient and either assign a username and password or let the system automatically generate this information. Under the Education link, click on the “New 1:1” button to assign a session and self-assessment(s). Alternately, if your patient is part of your class, you could navigate to the Classes tab, find your patient, and assign the self-assessment(s) there. You can then log into the http://patient.aade7.com site with the patient’s username/password and complete the assessment. The assessment data is captured in the Educator interface under that patient’s name. Pricing The AADE7™ System is available in three packages – Basic, Enhanced, and Multi-Program. Basic Package: AADE Members:

Free

Non-Members:

$49.00 per year per non-member

Click to purchase the AADE7™ System Basic Package Enhanced Package: AADE Members:

$79.00 per year per AADE member

Non-Members:

$99.00 per year per non-member

Multi-Program Package: This license allows an educator to document on an unlimited amount of programs for different patient populations. It has all the functionality of the Enhanced license, but is designed for the educator that has more than one DSME program. AADE Members and Non-Members:

$158.00 per year

Data Security and Entry AADE has processes and procedures in place to keep the AADE7™ System software and servers HIPAA compliant and secure, and AADE has redundant servers in offsite locations to minimize downtime. AADE does not have access to personally identifiable information (only aggregate, de-identified data) and has Business Associate Agreements in place with its service providers that require full HIPAA compliance. Also, AADE has revised its standard user Business Associate Agreement based on the changes made to HIPAA by the HITECH Act (otherwise known as the Health Information Technology for Economic and Clinical Health Act) and has instituted a new process to ensure that an appropriate Business Associate Agreement will be in place between AADE and each user of the AADE7™ System.

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FREE Mobile App:

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Assessing Literacy •

•

•

Not Reliable –

Asking directly

–

Asking educational status

Quick Techniques –

Reading a Pill bottle

–

Reading Nutritional Label

–

Signing name

–

Red Flags (Missed Appointments, misunderstanding, noncompliance, etc….)

Sample Validated Techniques –

REALM

–

TOFHLA

–

The Newest Vital Sign

- WRAT, SORT, PIAT REALM (Rapid Assessment of Adult Literacy in Medicine) •

Screening tool designed to measure adults’ ability to read common medical words or lay terms that correspond to anatomy or illnesses.

•

As a word recognition test, the REALM does not assess comprehension.

•

It is highly correlated with other tests of comprehension. It takes approximately 3 minutes to administer and score.

•

The REALM-R is a shortened version of the REALM, which consists of 8 items.

TOFHLA (Test of Functional Health Literacy in Adults) •

The full TOFHLA consists of a reading comprehension section as well as a numeracy section.

•

The former is composed of 50 questions, the latter of 17 items. The entire test usually takes up to 22 minutes to administer.

•

The reading passages and numeracy question are taken from common medical scenarios.

•

The s-TOFHLA is a truncated version that only uses questions from the reading comprehension subsection of the full test.

•

There are 36 items that are administered in 7 minutes.

•

The scoring categorizes respondents into inadequate, marginal or adequate levels of health literacy. 76

Newest Vital Sign (NVS) •

The NVS consists of a nutrition label with 6 accompanying questions to assess literacy.

•

It takes approximately 3 minutes to administer, and is meant to allow healthcare providers to make a quick assessment of patients’ literacy, which can then allow them to adapt communication to achieve better outcomes.

•

It assesses literacy and numeracy, and is available in both English and Spanish versions.

WRAT (Wide Range Achievement Test) •

The WRAT measures literacy in three categories: reading recognition, spelling, and arithmetic computation.

•

It takes 20-30 minutes to complete.

•

There is a level for children ages 5-11 (level I) and another level for ages 12-64 (level II).

•

In health-related research most investigators have only used the reading recognition sub-test which takes about 5 minutes to administer. Resources for Low Literacy Material

•

•

Writing your own: –

http://www.pfizerhealthliteracy.com/

–

http://www.ama-assn.org/ama/pub/category/8115.html

–

http://www.chcs.org/resource/hl.html

–

http://www.usability.gov/

Available Materials: –

http://www.fda.gov/opacom/lowlit/englow.html

–

http://www.nlm.nih.gov/medlineplus/healthtopics.html

–

www.niddk.nih.gov/health/eztoread.htm#dia

–

http://diabetes.niddk.nih.gov/dm/a-z.asp

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DEAP RESOURCES & CONTACT INFORMATION Ask a Question: [email protected] AADE Website: www.diabeteseducator.org DEAP Main Website Page: www.diabeteseducator.org/accreditation Peter Kim – DEAP Program Manager [email protected] – (312) 601-4861 Leslie Kolb, MBA, RN, BSN Director of Accreditation & Quality Initiatives [email protected] – (312) 601-4885

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