Translating Diabetes Science Into Clinical PracticePosted July 6, 2011 by Jennifer Larsen, MD
The science of diabetes care continues to evolve every year. Ultimately, however, that science will have no impact on health until it is translated into practice. The vast majority of diabetes care occurs in the primary care setting, particularly for the prevention and care of type 2 diabetes. Translation of diabetes care concepts and science begins in professional schools, but must continue beyond graduation into residency programs and continuing education of practicing providers. With health care reform, and the growing gap in the number of primary care physicians, moreover, mid-level providers—both physician assistants and advanced practice nurses, as well as pharmacists—will also be actively involved in delivery of diabetes care in the primary care setting and therefore need to be included in this process.
All effective models of diabetes care translation require participation of diabetes and endocrinology specialists with primary care providers, but there is no one model. At the University of Nebraska Medical Center (UNMC), the Diabetes Center is the hub of inter-professional diabetes education. That education begins in medical school, but the diabetes and endocrinology rotation is also required for internal medicine as well as family medicine residents, and intensively trains future providers about diabetes care in both the inpatient and outpatient setting. Physician assistant students and advanced practice nurses, as well as OB-GYN residents receive side-by-side education in these clinics. Diabetes and endocrinology faculty also participate in all required diabetes-focused core lectures and events for family medicine and internal medicine residents.
Effective continuing professional education is even more important to translation of new science. Like many diabetes centers, UNMC sponsors an annual regional diabetes education symposium focused on translating new paradigms of diabetes care. Diabetes faculty also participate in regional hospital-sponsored grand rounds programs across the state and provide lectures to groups of health professionals at their annual meetings. Case-based approaches or small group discussion may be more effective than lectures alone to translate science into day-to-day care.
Education continues through consultation notes, additional education of office staff and ancillary providers, and one-on-one conversations at professional meetings. Insurance companies also provide “carrots” and “sticks” to change practice behavior by regulating formularies and by identifying patients who have failed to meet desired goals, as well as by providing financial incentives to intensify care for patients most outside of those goals. New electronic health record systems represent yet another means of “prompts” that can help change practice from “the usual” to the “new standard.”
Some education also should and will be directed to the patients themselves. We struggle most with our patients who would benefit from behavior change—whether we’re targeting eating, physical activity, or medication administration. Behavior change may be better introduced in group education settings, or with technology. Cell phone or internet “messaging” and support, and devices located in the home to “report” on how the patient is doing, are being tested as we speak.
Translation of science into clinical care for improved health requires new models of education at all levels—for students, providers, and patients, as well as feedback from practice groups who are willing to evaluate these new models.
If you have thoughts or ideas about how to improve professional education and the translation of science to clinical practice please share them below.