Action Research: Development of a Diabetes Care Model in a Community Hospital
Keywords:
Action research, Care model, Diabetes, Diabetes care model, Model development, Nursing, Qualitative research, Thailand, Type 2 Diabetes MellitusAbstract
Diabetes mellitus is a major global health problem and it is essential to develop and implement appropriate healthcare delivery to improve diabetes care. This action research study developed a diabetes care model at a 120-bed community hospital in northern Thailand. Thirty multidisciplinary healthcare providers and 19 people with type 2 diabetes engaged as participants in this study. The research process comprised four phases: planning; action and observation; reflection and revision; and model summarisation. Qualitative data were collected using focus group discussions, semi-structured interviews, team meetings and workshops, document review, and observation with note taking. Content analysis was performed on the qualitative data.
The developed Diabetes Care Model for Community Hospitals has three components: administrative support; the diabetes care delivery system; and diabetes self-management support. Piloting of the model showed that it was practical, fitted with the situation and context of the hospital, and tended to produce good clinical outcomes.
Further studies of the effectiveness of this model are warranted especially in a longitudinal study. This Model is proposed to healthcare professionals and hospital administrators to be potentially used in service delivery in other community hospitals in Thailand.
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34. Kemmis S, McTaggart R. The action research planner. Victoria (VIC): Deakin University Press; 1990.
35. Masters J. The history of action research. In Hughes I. Action Research Electronic Reader. Sydney: The University of Sydney; 1995. Available from http://www. behs.cchs. usyd.edu.au/arow/Reader/rmasters.htm.
36. Henderson VA, Barr LCK, An LC, Guajardo C, Newhouse W, Mase R, et al. Community-based participatory research and user-centered design in a diabetes medication information and decision tool. Prog Community Health Partnersh. 2013; 7(2): 171–184. DOI:10.1353/cpr.2013.0024.
37. Koshy E, Koshy V, Waterman H. Action research in healthcare. California (CA): Sage Publications; 2011.
38. Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park, California (CA): Sage Publications; 1985.
39. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: Translating evidence into action. Health Affairs.2001; 20(6): 64-78.
40. Kisokanth G, PrathapanS, Indrakumar J, Joseph J. Factors influencing self-management of diabetes mellitus; a review article. Journal of Diabetology. 2013; 3 (1): 1-7.
41. Stringer ET. Action Research. 3rd edition. California: Sage; 2007.
2. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice. 2010; 87: 4-14.
3. Deerochanawong C, Ferrario A. Diabetes management in Thailand: a literature review of the burden, costs, and outcomes. Globalization and Health. 2013; 9:11: 2-18. Available from: http://www.globalizationandhealth.com/ content/9/1/11.
4. Chatterjee C, Riewpaiboon A, Piyauthakit P, Riewpaiboon W, Boupaijit K, Panpuwong N, et al. Cost of diabetes and its complications in Thailand: a complete picture of economic burden. Health and Social Care in the Community. 2011; 19(3): 289-98.
5. Diabetes Association of Thailand, The Endocrine Society of Thailand, Medical Department: Ministry of Public Health, National Health Security Office. Diabetes Management Guidelines. Bangkok: Srimuang; 2011. [Thai].
6. Rangsin R, Tatsanavirat P. An assessment on quality of care among patients diagnosed with Type 2 diabetes and hypertension visiting hospitals of ministry of public health and Bangkok metropolitan administration in Thailand, 2012. Bangkok (BKK): National Health Security Office; 2012. [Thai].
7. Collins MM, Bradley CP, Sullivan TO, Perry IJ. Self-care coping strategies in people with diabetes: a qualitative exploratory study. BMC Endocrine Disorders. 2009; 9(6): 1-9. DOI: 10.1186/1472-6823-9-6.
8. Arowobusoye N, Furlong C. Diabetes models of care: a briefing on models of diabetes management practice. London (LON): Author; 2008.
9. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro Alison, et al. The quality of healthcare delivered to adults in the United States. The New England Journal of Medicine. 2003; 348(26): 2535-2645.
10. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. Journal of American Medical Association.2002; 288(19): 2469-75.
11. Porter M, Kellogg M. Kaiser Permanente: An integrated health care experience. RISAI. 2008; 1(1): 2-8
12. Grover A, Joshi A. An overview of chronic disease models: A systematic literature review. Global Journal of Health Science. 2015; 7(2): 210-27.
13. Stellefson M, Dipnarine K, Stopka C. The chronic care model and diabetes management in US primary care settings: a systematic review. Prev Chronic Dis. 2013;10:120180. DOI: http://dx.doi.org/10.5888/pcd10.120180.
14. Piatt GA, Songer TJ, Brooks MM, Anderson RM, Simmons D, Orchard TJ, et al. Impact of patient level factors on the improvement of the ABCs of diabetes. Patient Educ Couns. 2011;82(2):266-70. DOI: 10.1016/j.pec.2010.04.005.
15. Khan MA, Evans AT, Shah S. Caring for uninsured patients with diabetes: designing and evaluating a novel chronic care model for diabetes care. J Eval Clin Pract. 2010; 16(4): 700-6.
16. American Association of Diabetes Educators. Integrating diabetes education in the chronic care model AADE practice synopsis. Issued September 25, 2014. Available from http://www.diabeteseducator.org/export/sites/aade/_ resources/pdf/general/ CCM_Synopsis_Final.pdf.
17. Patel NK, Parchman ML. The chronic care model and exercise discussions during primary care diabetes encounters. J Am Board Fam Med. 2011; 24: 26-32.
18. Si D, Bailie R, Weeramanthri T. Effectiveness of chronic care model-oriented interventions to improve quality of diabetes care: a systematic review. Primary Health Care Research & Devel. 2008; 9:25-40.
19. Sunaert P, Bastiaens H, Nobels F, Feyen L, Verbeke G, Vermeire E, et al. Effectiveness of the introduction of a chronic care model-based program for type 2 diabetes in Belgium. BMC Health Service Research. 2010; 10(207): 1-11.
20. Bureau of Non Communicable Disease, Ministry of Public Health. Manual of evaluation of implementing the noncommunicable disease quality clinic, the fiscal year 2013. Bangkok: Author; 2013. [Thai].
21. Jamrus C. Effectiveness of implementing nursing management guidelines for persons with diabetes type 2, Phrae Hospital [Thesis]. [Chiang Mai]: Chiang Mai University; 2012.107 p. [Thai].
22. Pulsri A. Development of clinical practice guidelines for promotion of exercise behavior among older persons with diabetes, diabetic clinic, Phang- Nga hospital [Thesis]. [Chiang Mai]: Chiang Mai University; 2011. 116 p. [Thai].
23. Khongruangrat Y. Effect of Fawn MorLumKlorn exercise on hemoglobin A1C level among persons with type 2 diabetes [Thesis]. [Chiang Mai]: Chiang Mai University; 2011.101 p. [Thai].
24. Meunya S. Effectiveness of implementing clinical practice guidelines for promotion of exercise behavior among older persons with diabetes mellitus, diabetes mellitus clinic, Uttaradit Hospital [Thesis]. [Chiang Mai]: Chiang Mai University; 2011. 107 p. [Thai].
25. Kaewalin S. Effectiveness of implementing clinical practice guidelines for promotion of exercise behavior among older persons with diabetes mellitus, Phayao Hospital[Thesis]. [Chiang Mai]: Chiang Mai University; 2011. 115 p. [Thai].
26. Sae-Sia W, Maneewat K, Kurniawan T. Effect of a selfmanagement support program on diabetic foot care behaviors. Int J of Res in Nurs. 2013; 4 (1): 14-21.
27. Wattanakorn K, Deenan A, Puapan S, Schneider JK. Effects of an eating behaviour modification program on Thai people with diabetes and obesity: A randomised clinical trial. Pacific Rim Int J Nurs Res. 2013; 17(4): 356-70.
28. Varee A, Klunklin A, Wichaikhum O. Development of an outpatient service system for diabetes mellitus, Sarapee hospital, Chiang Mai province. Nursing Journal. 2012; 39 (Number 1 January-March): 105-7. [Thai].
29. Pramchoo S. Healthcare network development for persons with diabetes mellitus, community hospitals [Thesis]. [Chiang Mai]: Chiang Mai University; 2012. 129 p. [in Thai].
30. Pratt JR. Long-term care: managing across the continuum. Massachusetts (MA): Jones and Bartlett Publishers; 2010.
31. Khunjandee T. Clinical situational analysis of care management to control blood sugar among patients with type 2 diabetes mellitus at Nan hospital [Thesis]. [Chiang Mai]: Chiang Mai University; 2011. 124 p. [Thai].
32. Elissen A, Nolte E, Knai C, Brunn M, Chevreul K, Conklin A, et al. Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches. BMC Health Services Research 2013; 13-117: 1-9.
33. Mc Hugh S, O’Mullane M, Perry IJ, Bradley C. Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice. BMJ Open 2013; 3: e003217: 1-9. DOI: 10.1136/ bmjopen-2013-003217.
34. Kemmis S, McTaggart R. The action research planner. Victoria (VIC): Deakin University Press; 1990.
35. Masters J. The history of action research. In Hughes I. Action Research Electronic Reader. Sydney: The University of Sydney; 1995. Available from http://www. behs.cchs. usyd.edu.au/arow/Reader/rmasters.htm.
36. Henderson VA, Barr LCK, An LC, Guajardo C, Newhouse W, Mase R, et al. Community-based participatory research and user-centered design in a diabetes medication information and decision tool. Prog Community Health Partnersh. 2013; 7(2): 171–184. DOI:10.1353/cpr.2013.0024.
37. Koshy E, Koshy V, Waterman H. Action research in healthcare. California (CA): Sage Publications; 2011.
38. Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park, California (CA): Sage Publications; 1985.
39. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: Translating evidence into action. Health Affairs.2001; 20(6): 64-78.
40. Kisokanth G, PrathapanS, Indrakumar J, Joseph J. Factors influencing self-management of diabetes mellitus; a review article. Journal of Diabetology. 2013; 3 (1): 1-7.
41. Stringer ET. Action Research. 3rd edition. California: Sage; 2007.
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2016-04-27
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Chaowalaksakun P, Nantachaipan P, Kunaviktikul W, Panuthai S, Kosachunhanun N, Turale S. Action Research: Development of a Diabetes Care Model in a Community Hospital. PRIJNR [Internet]. 2016 Apr. 27 [cited 2024 Nov. 18];20(2):119-31. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/23912
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