Title

Quality Matters: Maximising consumer outcomes through commitment to a National Evaluation Framework.
Background

The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government, administered by Diabetes Australia, aiming to enhance the capacity of people with diabetes. The National Services Group (NSG) provides Continuing Support Programs (CSP) to NDSS registrants to increase their understanding of their diabetes and the ability to self-manage the condition. Prior work by Eigenmann and Colagiuri identified four key domains associated with optimal adjustment to living with diabetes including knowledge and understanding; self-management; self-determination; and psychological adjustment (1). The National Evaluation Framework (NEF) was developed to aid in the categorisation of services delivered under the NDSS and guide evaluation processes based on the domains of the framework being addressed. The framework provides a series of tools to standardise not only the evaluation of programs and services, but also quality standards that programs must be measured against, and meet, in order to be endorsed by the NDSS.  The standards developed under the NEF have helped to consolidate programs and ensure that they have an evidence base; evaluation rigour; underlying philosophy of care; fidelity; and quality improvement pathway.

Aims

In order to progress the NEF, it was essential to endorse standards for structured diabetes education to provide a quality benchmark for CSP programs. Before evaluating consumer outcomes, it was important to know that the programs being offered through the NDSS met key quality criteria recognised internationally to be aligned with improved consumer outcomes. The NEF team aimed to gather evidence to support the development and endorsement of NDSS standards for structured diabetes education and an assessment tool to measure programs against these criteria. Additional aims included researching validated tools to support consistent evaluation measures for each domain of the framework to be applied across NDSS programs.
Methods
A review of national and international standards and guidelines for structured diabetes education was undertaken and a draft set of standards developed. Consultation with National Services Group leads across the country led to further refinement of the standards before presentation to an Expert Reference Group. Recommendations around the scope and intent of each standard were made and international evidence supporting each standard was discussed. An assessment tool was compiled to enable State and Territory Organisations (STOs) to assess their programs against the standards and determine where quality improvement may be required. At the same time, the NEF team conducted a thorough literature search of appropriate validated tools covering each domain of the framework, for presentation to the Expert Reference Group.
 
Results
The review and consultation process resulted in the development of eight key standards for structured diabetes education, which are applied to structured self-management programs under the NDSS. Each standard is clear, concise, and supported by a detailed explanation of the underpinning intent. The NDSS standards for structured diabetes education are mapped against international standards, aligned with NDSS principles, endorsed by the National Evaluation Expert Reference Group and support the Australian National Diabetes Strategy. The use of appropriate validated evaluation tools have been approved and endorsed by the Expert Reference Group.

Discussion

The NDSS standards for structured diabetes education, and the corresponding assessment tool, provide a mechanism for STOs to review and assess the quality, content and consistency of programs currently delivered under the NDSS. Programs that do not meet the criteria of the standards are required to undergo a quality improvement process and address gaps in the required area(s).  The development, endorsement and application of the NDSS standards, and the use of validated evaluation tools, support the provision of high quality, nationally consistent structured diabetes education programs across NDSS-funded STOs.  They also enable, for the first time in the history of the NDSS, nationally standardised evaluation of structured diabetes self-management education programs across all STOs. Within six months of introduction of the framework, results have shown statistically significant reduction in diabetes distress, and improvement in empowerment for self-management, among those attending education programs that meet the NDSS standards.
Nationally agreed upon standards currently do not exist for structured diabetes education in Australia. The development of the NEF, and the NDSS standards for structured diabetes education, may be applicable at a national level to chronic illness education programs.

Development of a national evaluation framework and quality standards for structured diabetes self-management education