• Paisley Johnson and Ginger Raterink.
• Cardiovascular Institute of San Diego, Chula Vista, CA, USA.
• J Clin Nurs. 2009 Jul 1; 18 (14): 2096-103.

ObjectivesThe American Association of Diabetic Educators suggests that educating patients about their diabetes management facilitates problem solving and coping skills. This paper will describe a clinic-in-a-clinic model of care delivery founded on the principles of the Chronic Care Model and focused towards the outcomes proposed by the American Association of Diabetic Educators. The reader will be introduced to the use of the 'plan, do, study, act' process used to develop this model in a clinical setting.BackgroundSelf-management support, a key component of the Chronic Care Model, focuses on providing patients with the skills to make healthcare decisions. Self-management encourages patient to be responsible for his/her own health care. Because diabetes outcomes and complication prevalence are related to the degree of self involvement in illness care, self-management support is an important component of disease management.DesignPlan, do, study, act model for program development.MethodsThe 'plan, do, study, act' cycles outlined the steps needed to implement the clinic-in-a-clinic program with success related to coordination of all components and continual assessment and revision. Each cycle was initiated in a sequential order allowing for evaluation and goal adjustment before the next cycle was implemented.ConclusionsThe majority of patients seen were middle-aged, obese, females with HbA1cs greatly above the recommended 7.0. Patients selected a variety of topics related to diabetes management for their clinical session. Participation rates were consistent with regular clinic visit attendance. Barriers to success of the program were related to both structure and process.Relevance To Clinical PracticeThe clinic-in-a-clinic design moves disease management from individual practice into a property of the health systems and places importance on the collaboration of patient, provider and delivery system in reducing the consequences of chronic illness. Use of the 'plan, do, study, act' cycle model offers a method for changing the process of care delivery in a structured, sequential approach.

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