Disclaimer: The following guide is my best guess on what content will be on the exam. I do not know what exactly will be on the exam but I have helped over a thousand health care professionals pass the exam.
Chapter 6- Organization of Diabetes Care
Importance: Medium- Read at least twice
Approximate time recommended: 45 min
I have highlighted what I think will be important for the exam. All areas in grey (key messages and recommendations) are also important for the exam. However you should read the entire chapter.
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Some of my students have found Chapter 6 and Chapter 7 confusing as they have inter-related information. I would suggest reading Chapter 6 as if you were the minister of health or a high level hospital executive. Pretend that you had the power to decide health system wide decisions like to either hire 1 endocrinologist or 10 nurses or 6 nurses, 2 pharmacists and 2 dietitians; or decide if patients will be seen in person or through tele-medicine; or how you would direct public money to community resources like food banks.
Under the heading of: Introduction
There are not enough endocrinologists to care for all the people with diabetes. That’s where we come in and help care for the ever growing population of people with diabetes in Canada.
Be familiar with the definition of the Chronic Care Model (CCM) and the definition of Quality Improvement (QI)
Components of the CCM that Improve Care
Be familiar with Table 1 and Figure 1
Be familiar will the six components of the Chronic Care Model and examples of each. A helpful way to become familiar with them is to imagine how you would implement them in your own practice. That way your not just memorizing info but finding useful ways to help with your own practice.
• Delivery system design
• Self-management support -> Is expanded upon in Chapter 7
• Decision support
• Clinical information
• The community
• Health systems
See the Standard of Diabetes Education below:
Practice Questions (press show answer to reveal answer)
The chronic care model reflects optimal diabetes care and seeks to transform the care of people with chronic illnesses from:
A) Planned and reward less to reactive and rewarding
B) Sporadic and population based to reactive and planned
C) Proactive and sporadic to planned and acute
D) Acute and reactive to planned and proactive
Ideally we want to transform chronic disease management from something this is acute and reactive to something that is planned, proactive, and population based. Diabetes is a chronic condition so we don’t want it treated acutely like a cold or cough. The person may go into remission but they will likely have diabetes for life. We don’t want a system that is reactive, we want to be proactive. This means that we have public health policies in the community that encourage people who are at risk to be screened, make the public aware of the risk factors and consequences of diabetes, and make the public aware of lifestyle changes that can prevent or slow down diabetes progression. We want to have plans and guidelines in place to treat people with diabetes with evidence and confidence.
A) Incorrect- Our ability of give rewards such as cash or incentives in the health care system is limited. While helping people with diabetes is rewarding and being helped with diabetes can be rewarding, we can’t really control who feels that.
B) Incorrect- reactive is incorrect but we do want plans
C) Incorrect- acute is incorrect but we do want plans
D) Correct- this entire statement is correct
Match the following item to their CCM component
| A) The community | 1) The 2018 Diabetes Canada clinical practice guidelines |
| B) Decision support | 2) Programs that increase food and housing security in your city |
| C) Self-management support | 3) A patient registry of all the people with diabetes in your practice |
| D) Delivery system design | 4) A plan for your patient to go skating with the grandchildren for 30 mins on Tuesdays and Thursdays |
| E) Health systems | 5) You and your role as a certified diabetes educator |
| F) Clinical information Systems | 6) A network of specialists in your province tackling diabetes foot care |
A)-> 2) Creating supportive environments such as food banks, coverage for diabetes supplies, and low cost housing falls into the Community category
B)-> 1) Guidelines, clinician education, auditing and bench-marking all fall under the category of Decision Support
C)-> 4) Behavioral modifications falls into the Self Management category
D) ->5) Delivery System Design encompasses how care is provided and who provides the care (hopefully you!)
E)-> 6) National and provincial programs designed to support people with diabetes and people who provide care to diabetes fall under the category of Health Systems
F)-> 3) Patient registries, electronic medical records (EMR) and other systems that allow for a population based approach to diabetes fall under the category of Clinical Information Systems
What do the 5Rs of Organizational Care stand for?
A) Review, Reward, Resource, Relay, Recall
B) Reinvent, Register, Record, Relay, Refer
C) Recognize, Register, Resource, Relay, Recall
D) Reinvent, Reward, Record, Remember, Relapse
E) Recognize, Register, Record, Report, Refer
A) Incorrect- incorrect, incorrect, Resource, Relay, Recall
B) Incorrect- incorrect, Register, incorrect, Relay, incorrect
C) Correct- Recognize, Register, Resource, Relay, Recall
D) Incorrect- incorrect, incorrect, incorrect, incorrect, incorrect
E) Incorrect- Recognize, Register, incorrect, incorrect, incorrect
Which of the following is part of the community in the expanded chronic care model and not part of the health system?
A) Delivery system design
B) Building healthy public policy
C) Decision support
D) Information systems
A) Incorrect- this is a part of the healthcare system. Designing how to best deliver care which we are part of.
B) Correct- this is part of the community, specifically the government and politicians deciding on health promotion policy
C) Incorrect- this is part of the healthcare system. Providing information and guidelines to clinicians (like us) who serve people with diabetes
D) Incorrect- this is part of the healthcare system. An example of this is the electronic medical record you use.
Please see figure 1 on pg S30 of the 2018 Diabetes Canada clinical practice guidelines for details.
Which of the following is not true about telehealth?
A) Can improve self management in underserviced areas
B) Facilitate consultation with specialized teams as part of a shared-care model
C) Replace the need for specialist care and foot care in underserviced areas
D) Improve glycemic and cardiovascular risk factor control in type 1 and type 2 diabetes
Remember to look out for NOT questions on the exam. I want you to pass and suggest that whenever you see the word NOT or which if the following is INCORRECT or EXCEPT that you circle it. That will remind you to look for the not true or incorrect answer instead of the correct one.
A) Incorrect- telehealth can improve self management in underservices areas by providing more frequent follow up
B) Incorrect- telehealth can facilitate specialty teams such as endocrinology, pump trainers, mental health services to call in to areas that don’t have access to these services
C) Correct- telehealth cannot replace endocrinologists, foot care specialists, nephrology, etc.
D) Incorrect- there is evidence that telehealth does improve these risk factors