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DSMT Toolkit

Chapter 25. Sample AADE Chart Auditor Checklist

Educational Record Review Form

Item Comments
Referral for DSME/T in chart Must be by the treating physician or midlevel practitioner
Relevant medical history Other diagnosis or co-morbidities basically a health history
Present health status, health service or resource utilization What is going on now, do they see the doctor often, have they had dental exam, foot exam, visual exam etc.
Risk factors Genetic, obesity etc.
Diabetes knowledge and skills Past education, do they monitor etc.
Cultural influences Any special diet or herbs … special resources needed i.e. members of tribal communities will often not comply unless the chief agrees with treatment
Health beliefs and attitudes Misconceptions, prayer …
Health behaviors and goals Goal setting and usual behavior
Support systems Do they live alone, married …
Barriers to learning Education level, literacy issues, blind, deaf …
Socioeconomic factors Financial situation
Collaborative participant assessment Overall assessment either completed with the patient or reviewed after completion with the patient
Plan of care based on assessment and meets the individual’s needs Actual plan of care
Intervention per plan provided and outcomes evaluated Follow-up with items in plan, interventions, education, teach back etc.
Collaborative development of education goal, objectives and plan Who set the goals and what is the plan
Is the AADE7 Integrated Is the 7 self-care behaviors a part of the overall plan
Communication of educational services to physician/ qualified non-physician practitioner (Standard 8) Documentation of the communication with the physician or midlevel practitioner. Not sufficient for policy to say EHR
Does the chart show evidence of a personalized process for on-going self-management support?(Standard 8) What have you encouraged your patients to do after education, resources (websites, booklets, local community services, weight programs

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