The standard acute care model has been demonstrated to be ineffective at treating chronic care illnesses, such as diabetes. Therefore, alternative methods of delivering care should be considered. Improvements in self-management support, delivery system design, decision support, and clinical information systems can all be addressed in an effort to achieve this goal. One method of affecting organizational change is through the use of short-change cycles or PDSA cycles - standing for Plan, Do, Study, Act. Preliminary data using PDSA cycles to impact key quality indicators on diabetic care at the Lower Elwha Health Clinic, suggests that using these cycles, especially in areas needing significant improvement, can positively impact diabetes management. In two areas using PDSA cycles: A 39% increase was realized in the incidence of documented aspirin use: to a total of 68% of patients over a five-month period. A 45% increase was realized in the number of patients with documented self-management goals over the same period, to an overall total of35% of patients. In summary while the data is preliminary, inferences can be drawn that PDSA cycles were at least partly responsible for improved quality measures. It is theorized that the utility of change cycles lies in its 1) structured process for addressing a problem, 2) its relative low risk approach to solving a problem, 3) its ability to break large steps into smaller more manageable parts.
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