XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.

An Ecological Perspective on Health Promotion Programs

This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.

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Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

Building Leadership Effectiveness This program encourages leaders to develop practices that transform values into action, vision into realities, obstacles into innovations, and risks into rewards. Participants will be introduced to the five practices of exemplary leadership: modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart Coaching & Communicating for Performance Coaching & Communicating for Performance is a highly interactive program that will give supervisors and managers the opportunity to build skills that will enable them to share expectations and set objectives for employees, provide constructive feedback, more effectively engage in learning conversations, and coaching opportunities. Skillful Conflict Management for Leaders As a leader, it is important to understand conflict and be effective at conflict management because the way conflict is resolved becomes an integral component of our university’s culture. This series of conflict management sessions help leaders learn and put into practice effective strategies for managing conflict.

기독교 사역과 Leadership

The purpose of this article is to demonstrate a model for collaboration between program providers and program evaluators. The article describes how university-based evaluators, a state health department, and local program providers collaborated to evaluate 12 projects implementing commercially developed teenage pregnancy prevention (TPP) programs in school settings. Approximately 2,200 students participate annually in the programs. Program evaluation staff and local program providers worked together to construct logic models that helped guide the intervention and evaluation design. The local providers also participated in training sessions, conducted by the evaluation team, to increase their understanding and skills related to program evaluation methods. Student-level outcomes related to knowledge, attitudes, skills, behaviors, as well as an assessment of curricula fidelity were included in the evaluation. The result of this collaborative model has been a quality program evaluation for the projects while maintaining community input regarding program improvements that reflect local population needs.

A Collaborative Approach to Program Evaluation of Community-Based Teen Pregnancy Prevention Projects

Adolescent pregnancy is a significant public health problem. The adolescent pregnancy rate in the United States is higher than in many other industrialized nations. Reviews of programs designed to prevent teen pregnancy conclude that few effective interventions exist. This article describes a promising approach to teen pregnancy prevention currently underway in diverse neighborhoods in Oklahoma City. The project—Healthy, Empowered and Responsible Teens of Oklahoma City-is asset-based and focuses on positive youth development. The needs and assets assessment and the evaluation methodologies are described in detail. The methods are both qualitative and quantitative and include key informant interviews, focus groups, data mapping, observation, collection and content analysis of documents, case studies, a neighborhood youth and resident survey, community leader survey, and organizational network survey. Concepts measured in the evaluation include neighborhood mobilization and planning, implementation, institutionalization, sustainability, assets at multiple levels, risk behaviors associated with adolescent pregnancy, and teen birth rates.

Combining Quantitative and Qualitative Techniques in Planning and Evaluating a Community-Wide Project to Prevent Adolescent Pregnancy

This study reports on the evaluation of the second North Carolina Healthful Living Institute (HLI), a statewide conference to promote comprehensive school health education. A comparison of year one and year two evaluation results is included. Based on a theoretical framework derived from the theory of diffusion of innovations within organizations, the impact of the HLI was assessed by studying characteristics of school districts sending representatives to the HLI and the composition of teams from each school district, and using pretest and posttest measures of participants' perceptions of the importance of health as a content area and participants' perceptions of the importance of the various components of comprehensive school health. Results indicate the effect of school health promotion conferences is linked to characteristics of school district teams, with the Institute needing to attract more varied teams, and teams from smaller, rural districts.

Promoting comprehensive school health programs through summer health promotion conferences.

The importance of school district policies in the dissemination of tobacco use curricula in North Carolina schools

Over the past 20 years, teenage birth rates in the United States have declined substantially but continue to persist among certain populations. During this time period, a series of rigorously tested teen pregnancy prevention (TPP) programs were developed, and a number of evidence-based interventions (EBIs) emerged. In April 2017, researchers reviewed EBIs in TPP and examined each program's socioecological levels of intervention, measurements approaches, and other ecological aspects. Findings indicate that the majority of TPP EBIs are aimed at the individual and/or interpersonal level of intervention. Furthermore, the programs were evaluated using the individual as the unit of analysis, regardless of what level the EBI targets. These findings represent serious gaps, specifically a lack of system-, environmental-, and policy-level EBIs. Future TP approaches should target multiple levels of social ecology, ensure measurements appropriately capture changes within these levels, and shift to a focus on a longer term population health improvement.

Kenneth R. McLeroy

Papers

A Collaborative Approach to Program Evaluation of Community-Based Teen Pregnancy Prevention Projects

Combining Quantitative and Qualitative Techniques in Planning and Evaluating a Community-Wide Project to Prevent Adolescent Pregnancy

Promoting comprehensive school health programs through summer health promotion conferences.

The importance of school district policies in the dissemination of tobacco use curricula in North Carolina schools

Ecological Approaches to Teen Pregnancy Prevention: An Examination of Evidence-Based Interventions.