I have been a Certified Diabetes Educator (CDE) for 6 years, and had the privilege of attending the last 3 American Association of Diabetes Educators (AADE) annual meetings. These meetings have shown me the national "bigger picture." Attending has been critical to developing my practice.

During the 2001 AADE annual meeting I was inspired by a presentation given during the Home Health Care Diabetes Educators Specialty Practice Group by Barbara Gibson, RNC, CDE, of R&R HomeCare, Inc., of Louisiana. The program described the way Barbara led her agency in developing a diabetes education program recognized by the American Diabetes Association (ADA). I thought, if she can do it, we could do it!!

Our agency is a nonprofit VNA in Massachusetts providing 125,000 home visits per year to approximately 6,000 patients. I shared the idea with my managers, but because other priorities were already set, I was asked to continue to see patients and run the current program, and lead a few talks per year. I was, and remain, overwhelmed by the diabetes needs in our area. Standards of care were not fully integrated into the practices of physicians and other providers.

After the AADE meeting in 2002, I read the Conceptual Framework of the National Diabetes Education Outcomes System (NDEOS) (Peeples, 2001). This described how a diabetes educator can work within various settings and after clarifying my practice I presented a proposal to administration suggesting we use the 10 ADA Standards to organize our program and track outcomes.

The administration supported the proposal because we had just completed training on laptops. The Joint Commission requirement that we have an outcomes project also supported my cause, as the agency needed another OBQI (Outcomes) project for reaccreditation. We formed a committee that has matched our diabetes care plan elements up with The Seven Guiding Principles of Diabetes Care using the care plan in our agency's computer system. The patient chooses which of the behaviors he or she wishes to focus on, most often choosing food, monitoring, or medications. We are collecting certain OASIS data elements for a pilot outcomes study.

We have begun to establish a team of diabetes instructors by:

* sending nurses to educational programs (e.g., a 2-day Joslin Diabetes Center program motivated two RNs to become CDEs!!);

* meeting every 2 weeks with these nurses to enhance their patient education efforts, and help them participate in the pilot study; and

* using a patient curriculum that contains the 7 behaviors.

Additional Organization Outcomes

Unexpected positive agency outcomes have also arisen. A pharmaceutical company that reviewed our plan provided an educational grant to send two more nurses to Joslin in 2004. Our committee plans to identify specific outcomes to present to HMOs. An additional benefit of our diabetes program is that supervisors are considering using the same concepts to track outcomes in our cardiac and wound care programs.

My dream of an evidence-based diabetes program with measurable outcomes is becoming a reality. Try it in your agency-everyone can benefit!!

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