Using the Behavior Score Dashboard

Using the Behavior Score Dashboard
Tracking behavior change and patient progress has just become simpler. AADE has
worked with diabetes educators, behaviorists, and measurement experts to develop
Behavior Score Tools that will allow you to measure and track individualized behavior
change. These tools are free to practicing diabetes educators (DEs) who are members of
AADE and available at a minimal annual fee for all diabetes educators.
The Behavior Score Dashboard (BSD) was designed to support three major objectives:
1. A beginning (an ongoing) conversation with patients to examine all areas of
diabetes management that are key to their success
2. A tool that provides the framework for how diabetes education and training are
to be addressed in the practice setting
3. A means of measuring both patient progress and professional practice outcomes.
The 2011 rollout of the Behavior Score Dashboard is predominately targeting the first
objective and teaching diabetes educators (DE) how to use it. As a stand-alone
instrument, as part of the Patient Self-Assessment Initial Patient Self-Assessment, or as
part of a systematic approach (example, AADE7 System™), in its current form the BSD
is a robust tool that provides DE with an evidence based, data collection tool that can
used to initiate DSME/T then track care planning and patient progress.
The BSD also addresses the second and third objectives by providing the potential for a
standardized approach to patient assessment for Diabetes Self-Management Education /
Training. Capturing actual performance measures and linking to health outcomes will be
dependent on the specific delivery system in which the DE practices.
How to Use the Behavior Score Dashboard with Patients
The BSD can be used in patient care to:
1. establish a plan of care that fully involves the patient
2. be used as a reference to discuss patient efforts and progress
3. help the person with diabetes see change over time
There are 21 core questions (3 for each behavior) in the BSD. These questions have also
been integrated into the AADE Patient Self-Assessment Initial Patient Self-Assessment
and AADE Follow-up Patient Self-Assessment. Many DEs currently assign the AADE
Patient Self-Assessment Initial Patient Self-Assessment to the people with diabetes to
whom they provide services. The Patient Self-Assessments can be assigned directly
through the AADE7 System™ or downloaded as hard copy (A downloadable Spanish
Version of the Patient Self-Assessment Initial Patient Self-Assessment is also made
available from the AADE7 System™ Document Center) that can be provided to the
person with diabetes when they attend the first DSME/T session.
If a DE assigns the AADE Initial and Follow-up Self-Assessment to all those receiving
DSME/T, he/she will not need to use the stand-alone version of the BSD. Hence, the
remainder of this document will not be relevant. Instead, the DE will wish to read the
User Guide for the AADE Patient Self-Assessment.
Instructing the Person with Diabetes in Completing Questions in the Behavior Score
The dashboard has been designed to be colorful, interactive and provide “instant”
information. Once completed, scores are immediately visible and can guide the way to
creating a plan with the patient. The Behavior Score Dashboard is not an end point.
Rather it allows the person with diabetes to set the agenda for the discussion while
staying focused on the critical self-management behaviors.
The first step is to give the person with diabetes an opportunity to respond to the
questions about the seven behaviors. Before they begin, instruct them that there are no
‘right’ or ‘wrong’ answers. Also explain that they will have other opportunities to
discuss their answers, as their “scores” are just the starting point towards building their
own customized plan.
If the person with diabetes will be responding to the BSD by computer, take a few
moments to make certain s/he is logged on and understands how to respond to the
questions and how to use the computer! Let them know that they are going to be
selecting a number for each question that best represents what is happening right now,
not what they hope will be happening in the future. Again, assure them that there are no
‘right’ or ‘wrong’ answers.
Someone should be close at hand to help the person with diabetes work through the BSI
if they need help. And before they log off of the computer, review the questions quickly
to be sure that all were answered.
Since the focus is on engaging the patient’s attention and involvement, it is suggested that
you print off a copy to use during the time with the person with diabetes (and maybe even
a color copy for the patient, if you think this would be helpful at that point).
Reviewing the Behavior Score Dashboard to Plan Care
Sit with the person with diabetes and review the questions and their answers. Get the
‘big picture’ view of all seven (7) behaviors before focusing in on only one. The
questions themselves are opportunities to explore and better define the education/training
issues that the person with diabetes might be ready to address.
Where there are low scores that indicate the behaviors are difficult to do or maintain, ask
the person with diabetes about their experiences in that/those areas. A leading question
might be: “I see that you scored this low. Can you tell me more about why you see this
as a low score area?” “What has been your experience in managing (food, activity,
monitoring, etc.)?”
Where scores indicate that the person with diabetes perceives him/herself as doing well
with maintaining that set of behaviors, ask them how they got to that point. It at all
possible, emphasize the positive and create an environment of success (no matter how
modest). Let the person with diabetes know how this can positively affect overall
diabetes management.
After discussing the patient’s scores, the next step is to configure the information into a
plan. The educator’s function is to help the person with diabetes see how the behaviors
fit together to support improved glycemic control and diabetes management, and then
s/he begins the work of crafting a plan of self-management that fully utilizes the patient’s
involvement. At this point, the educator may move into their own approach or style of
education, but they are doing so using the BSI as a framework of the key areas that need
to be addressed. This is also where the diabetes educator’s expertise and skills are fully
utilized to determine how to proceed to best help that individual patient. Even if the plan
starts small, the BSI information can be used to identify some short term and intermediate
goals, and the DE and person with diabetes together can determine how best to get there.
Next Steps – Use of the BSD in On-Going Self-Management Education / Training
The BSD can be used at subsequent patient – educator sessions, perhaps as a starting
point to reconnect, and focus on that session’s agenda. Referring back to the Plan
activities, the BSI can also be referenced to see if perceptions and/or behaviors are
changing. In this way, it can be a helpful tracking device.
So, should person with diabetes “retake” the BSI at every visit / encounter? Behavior
change – real behavior change – takes time, and the behavior has to be maintained for at
least six weeks to have any beginning confidence that new behaviors are being
established. To ask the person with diabetes to repeat the BSI earlier than three months,
is not likely to be helpful, and can even slow progress if the person with diabetes gets
frustrated and downhearted.
The BSI can serve as a guide, but it should not be over-administered so that it loses the
core intent which is to help the person with diabetes “see” ways and possibilities to be
successful in areas that are central to successful diabetes management.