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

Issues in risk communication

The article by Elliott and colleagues describes a national research program aimed at investigating dissemination and organizational capacity for heart health promotion in formal and informal public health systems in Canada. The 15-year Canadian Heart Health Initiative has four phases: policy development, provincial heart health surveys, demonstration projects to develop best practices at the community level, and a dissemination phase. The national research program described in this article focuses on the latter phase and has the potential to significantly advance our understanding of how to translate research into practice. The article touches on a number of complex concepts in health promotion. Our main criticism of the article is that it lacks detail. The article does, however, raise many intriguing questions that we will focus on in this commentary. First, what is the relationship between organizational capacity and dissemination? How much capacity is necessary to facilitate dissemination? How can dissemination build organizational capacity? The conceptual framework for the research program shows dissemination projects with a unidirectional arrow leading to organizational capacity, thereby implying that dissemination influences capacity, but capacity does not influence dissemination. Although it is possible that dissemination of innovative ideas and programs can increase capacity, it seems likely that the capacity of an organization will affect the extent to which an organization becomes aware of an innovation and the extent to which the organization will consider adoption of the innovation. Indeed, in the narrative, the authors acknowledge that some dimensions of capacity, such as the availability of sufficient material and human resources, may be prerequisites for successful dissemination. Thus, it will be important to

Commentary on “Conceptualizing Dissemination Research and Activity: The Case of the Canadian Heart Health Initiative”

An introduction is presented in which the authors discuss the supplemental issue of the journal which examines the replication typology and guidelines for adolescent pregnancy prevention programs in America, as well as the U.S. Department of Health and Human Services' Office of Adolescent Health.

Kenneth R. McLeroy

Papers

Issues in risk communication

Commentary on “Conceptualizing Dissemination Research and Activity: The Case of the Canadian Heart Health Initiative”

Replication Typology and Guidelines for Adolescent Pregnancy Prevention Initiatives.

ViewPoint: conversation with Kenneth R. McLeroy, PhD. by David R. Black and Molly T. Laflin.

On public health and the military.