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CARIDIAB: Caribbean Diabetes Project

Guiding and Supporting National Quality Improvement Initiatives for Diabetes in Less Well-Served Parts of the World: A Proof-of-Concept Project in the Caribbean. International Learning Session I / LS1, St. George's, Grenada, 18–19 December 2008. A Joint Activity of PAHO and the World Diabetes Foundation (WDF).

Aim: Develop a plan to implement a strategy to improve the quality of diabetes care in the Caribbean.

  • Review the status of diabetes care in the Caribbean
  • Review methodological details including the Chronic Care Model, the Breakthrough Series, and the Assessment of Chronic Illness Care (ACIC) tool.
  • Develop a plan for health provider training on different aspects of diabetes management following the Caribbean Health Research Council Guidelines.
  • Develop an intervention plan for quality of diabetes care improvement.

Participants: National teams from participating countries ( Antigua and Barbuda, Anguilla, Barbados, Grenada, Guyana, Jamaica, St. Lucia, Trinidad and Tobago, and Suriname) and selected faculty members. Belize was also invited to attend.


icon Report (20 pp)| icon Presentation, Day 1 | icon Presentation, Day 2  | About the project

Workshop Summary, Learning Session I

In compliance with the project protocol, members of National Diabetes Teams from nine Caribbean countries participated in the project’s first international learning session (LS1).

Chronic Care Model

During the course of the meeting, country representatives were introduced to the Chronic Care Model (on which the project was developed) in detail along with several other tools that are available for the evaluation of care in clinical settings (including a chart review, interviews, and cost analysis), diabetes registries as a tool to improve clinical care, the Diabetic Care Pathway and the Quality Improvement Cycles. Examples of interventions utilized in Central American countries ( Mexico, Guatemala, El Salvador, Costa Rica and Nicaragua) to improve the quality of their diabetes care (e.g. clinical information systems, training in foot care, education and capacity building) were also presented. Countries and territories outlined their tentative strategies for intervening and established timelines for the interventions.

According to the protocol of the project leaders of national diabetes team will be tasked with implementing an assessment of national diabetes care will be undertaken within each country using the questionnaire devised by the World Health Organization (National Capacity Survey for Chronic Diseases, focused on diabetes) attached. The survey will provide an overview of key aspects of the health care system with respect to diabetes. Persons in charge of national teams are responsible for carrying out these baseline assessments, with the technical support of the PAHO CNCD Advisor.

National diabetes teams should then implement a quality of diabetes care improvement intervention. This intervention consist in three learning sessions that will include training of health providers to improve the quality of care based in selected priorities followed by three action period. The learning session will consist in training, priority selection and planning. During the action periods the teams will carry activities to improve diabetes care. The intervention can be monitored using one or various tools that were provided during ILS-1, such as the Patient Record Card, the Assessment of Chronic Illness Care (ACIC) questionnaire, the Pan-American Sentinel Surveillance or the diabetes registry (CDEMS). The selected tool should be applied before the first action period and after the third and last action period.

National teams should meet periodically to plan and evaluate the national strategy to implement the interventions.

During the first learning session, national teams will train the local teams (teams in the primary health clinics etc) in the Caribbean Health and Research Council’s Guidelines for the Management Diabetes Mellitus in Primary Care in the Caribbean and discuss with the local teams the other interventions (e.g. training for providers and patients in footcare, education of patients and providers etc.) which will be implemented to improve the quality of Diabetes care in participating countries. The Pan American Health Organization can provide faculty members (experts in Diabetes Mellitus) to assist countries with the training component. During the learning sessions health providers will select priorities for the quality improvement project and will present results of activities.

Caribbean Chronic Care Collaborative (CCCC)

National team are suggested to implement Quality Improvement Cycles of Plan-Do-Study-Act (PDSA) during the action periods to achieve the desired changes identified during the learning sessions, share information with each other and have the opportunity to contact the experts to clarify any concerns and receive technical assistance. The identified local coordinators will be responsible for summarize information for the evaluation of teams. The leaders of the collaborative will begin to prepare the report which will be shared with other members of the local and national team. The report will include the goals, performance measures, summaries of the PSDA cycles that have been carried out, monitoring forms and the self evaluation of achievements. Together with the faculty members, the teams will prepare for the second and third learning session which will be scheduled later in the year. Detail list of priorities identified by country participants is presented in Table 1. A list of country teams is presented in Annex 1. Annex 2 presents a description of faculty functions and a list collaborators across the Caribbean. Annex outlines available abstracts of relevant articles.


Last Updated on Monday, 25 January 2010 10:41

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