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Projections indicate that in the year 2010, prevalence of diabetes in the Caribbean will reach 25% of the adult population.
The countries of the Caribbean face particular challenges in the delivery of diabetes care since their small size often means that they lack the breadth of expertise needed. Moreover, a combination of genetic predisposition and unfavourable environmental factors makes the situation even more demanding.
However, there is good evidence that through the provision of good diabetes care and the empowerment of people with diabetes a substantial proportion of diabetes related complications can be prevented. In addition, many of the interventions to improve outcomes are highly cost effective.
As a result, there is a substantial need to achieve real and sustained improvements in the quality of diabetes care and outcomes in the Caribbean.
Approach
Ten countries in the Caribbean will be selected to participate in the project initiated by the Pan American Health Organization (PAHO) in co-operation with the WHO Collaborating Centre for Training, Evaluation, and Research in Diabetes, Uni. of Newcastle. The selection of the participating countries has been based on the degree of commitment indicated by the Ministry of Health in the target countries.
Initially, an assessment of national diabetes care is undertaken within each country using questionnaires and checklists provided by the WHO, which will provide an overview of key aspects of the health system with respect to diabetes.
Each country will establish a national technical committee, which will conduct the intervention at a later stage. The committee consists of a senior member of the Ministry of Health and to clinicians.
The members of the national committees will participate in an initial training workshop where they will receive training and detailed instruction on the implementation of Collaborative Quality Improvement, including the Chronic Care Model, breakthrough series methodology, assessment of the Chronic Illness Tool and the Pan-American VICEN. The latter being a tool used to determine quality of care in a clinical setting.
Meanwhile, an assessment of Chronic Illness Care is carried out for the national systems of the countries and each of the participating health centres. The objective is to identify weak areas of the Chronic Care Model; the clinics will subsequently focus their interventions on these weak spots.
Upon completion of the assessments, the national committees will train local teams in the collaborative methodology and the local teams will identify the areas in which they will focus the improvement activity. The teams should develop plans to implement and evaluate the chosen intervention to improve quality. Since each intervention is tailored to the needs and available resources of the local situation, it is not possible to specify what each intervention will be prior to this stage.
The local teams then follow the Quality Improvement Cycles of Plan-Do-Study-Act (PDSA) to implement changes and share information. Throughout the process they will have the opportunity to receive technical assistance from a group of experts. In addition, a report is written on the goals, performance measures, monitoring forms etc.
Then the local teams attend another training session during which they will report on the activities, accomplishments and experiences to date. The teams will also identify more actions which can be tried and applied for each component of the Chronic Care Model in addition to receiving training in special topics such as foot care and patient education.
Once again the teams return to their local settings to implement the identified activities.
A third training session is then conducted for the local teams. During this session focus is on self-evaluation of the implementation of the Chronic Care Model, incorporating collaboration, describing strategies of sustainability, making presentations of the measuring of the improvements and supporting the team in developing plans for testing and implementations of the components of the Chronic Care Model.
When the teams return they will work on the implementation of the improvements in the care system.
Finally, an event is held to share the success stories and celebrate the achievements reached. The event includes promoting the Chronic Care Model to the media and inviting other countries to learn from the project, with the hopes of initiating a quality improvement intervention in the future. | 
