RT Journal Article
SR Electronic
T1 Results of a Mixed-Methods Evaluation of Partnerships for Health: A Quality Improvement Initiative for Diabetes Care
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 711
OP 719
DO 10.3122/jabfm.2013.06.120211
VO 26
IS 6
A1 Stewart Harris
A1 Jann Paquette-Warren
A1 Sharon Roberts
A1 Meghan Fournie
A1 Amardeep Thind
A1 Bridget L. Ryan
A1 Cathy Thorpe
A1 Amanda L. Terry
A1 Judith Belle Brown
A1 Moira Stewart
A1 Susan Webster-Bogaert
YR 2013
UL http://www.jabfm.org/content/26/6/711.abstract
AB Purpose: Quality improvement (QI) initiatives have been implemented to facilitate transition to a chronic disease management approach in primary health care. However, the effect of QI initiatives on diabetes clinical processes and outcomes remains unclear. This article reports the effect of Partnerships for Health, a QI program implemented in Southwestern Ontario, Canada, on diabetes clinical process and outcome measures and describes program participants' views of elements that influenced their ability to reach desired improvements. Methods: Part of an external, concurrent, comprehensive, mixed-methods evaluation of Partnerships for Health, a before/after audit of 30 charts of patient of program physicians (n = 35) and semistructured interviews with program participants (physicians and allied health providers) were conducted. Results: The proportion of patients (n = 998) with a documented test/examination for the following clinical processes significantly improved (P ≤ .005): glycosylated hemoglobin (A1c), cholesterol, albumin-to-creatinine ratio, serum creatinine, glomerular filtration rate, electrocardiogram, foot/eye/neuropathy examination, body mass index, waist circumference, and depression screening. Data showed intensification of treatment and significant improvement in the number of patients at target for low-density lipoprotein (LDL) and blood pressure (BP) (P ≤ .001). Mean LDL and BP values decreased significantly (P ≤ .01), and an analysis of patients above glycemic targets (A1c >7% at baseline) showed a significant decrease in mean A1c values (P ≤ .01). Interview participants (n = 55) described using a team approach, improved collaborative and proactive care through better tracking of patient data, and increased patient involvement as elements that positively influenced clinical processes and outcomes. Conclusions: QI initiatives like Partnerships for Health can result in improved diabetes clinical process and outcome measures in primary health care.