Braden Manns1, Ted Braun2, Alun Edwards3, Jeremy Grimshaw4, Brenda Hemmelgarn1, Don Husereau4, Noah Ivers5, Jeff Johnson6, Steve Long7, Kerry McBrien8, Christopher Naugler9, Peter Sargious10, Sharon Straus11, Marcello Tonelli12, Andrea C Tricco11, Catherine Yu11. 1. Department of Medicine, University of Calgary, Calgary, Alta. ; Libin Cardiovascular Institute and Institute for Population Health, University of Calgary, Calgary, Alta. 2. Interdisciplinary Chronic Disease Collaboration, University of Calgary, Calgary, Alta. ; Department of Family Medicine, Alberta Health Services, Calgary, Alta. 3. Department of Medicine, University of Calgary, Calgary, Alta. ; Obesity, Diabetes and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alta. 4. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont. 5. Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Ont. ; Department of Family and Community Medicine, University of Toronto, Toronto, Ont. 6. Obesity, Diabetes and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alta. ; Department of Public Health Sciences, University of Alberta, Edmonton, Alta. 7. Alberta Health, Edmonton, Alta. 8. Interdisciplinary Chronic Disease Collaboration, University of Calgary, Calgary, Alta. ; Department of Family Medicine, University of Calgary, Calgary, Alta. 9. Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta. ; Calgary Laboratory Services, Calgary, Alta. 10. Department of Medicine, University of Calgary, Calgary, Alta. 11. Department of Medicine, University of Toronto, Toronto, Ont. ; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont. 12. Interdisciplinary Chronic Disease Collaboration, University of Calgary, Calgary, Alta. ; Department of Medicine, University of Alberta, Edmonton, Alta.
Abstract
BACKGROUND: Strategic clinical networks, a recent development in the health system in Alberta, have been charged with bringing together front-line clinicians, researchers and policy-makers to identify variation in clinical care, and to propose standards, pathways and innovative solutions to improve access and quality of care. Here, we describe a collaborative workshop held between researchers and the Obesity, Diabetes and Nutrition Strategic Clinical Network to describe barriers to and facilitators of care for people with diabetes and to identify quality improvement interventions that should be prioritized. METHODS: Through collaboration between health researchers and the strategic clinical network, and using principles of the knowledge-to-action cycle, we identified barriers to and facilitators of diabetes care using data from a patient survey and a provider focus group (5 primary care physicians and 1 diabetes educator). In addition, we identified best evidence from a systematic review of quality improvement initiatives in diabetes. This information was reviewed at a multistakeholder workshop where potential quality improvement initiatives were considered at various service levels. RESULTS: A pilot survey involving 59 patients with diabetes and a focus group of primary care and allied health care providers identified several important barriers to optimal outcomes in diabetes care, including patient-level financial barriers to care and difficulty navigating the health system. Our collaborative discussion using the knowledge-to-action cycle prioritized feasible, evidence-based interventions to improve outcomes for patients with diabetes, including enabling care by allied health care providers and creating clear care maps and processes for system navigation. INTERPRETATION: We identified important barriers to achieving optimal outcomes in diabetes that may be overcome through the use of evidence-based quality improvement interventions. As recommended within the knowledge-to-action cycle, future research is required to determine whether program implementation improves outcomes and is cost-effective.
BACKGROUND: Strategic clinical networks, a recent development in the health system in Alberta, have been charged with bringing together front-line clinicians, researchers and policy-makers to identify variation in clinical care, and to propose standards, pathways and innovative solutions to improve access and quality of care. Here, we describe a collaborative workshop held between researchers and the Obesity, Diabetes and Nutrition Strategic Clinical Network to describe barriers to and facilitators of care for people with diabetes and to identify quality improvement interventions that should be prioritized. METHODS: Through collaboration between health researchers and the strategic clinical network, and using principles of the knowledge-to-action cycle, we identified barriers to and facilitators of diabetes care using data from a patient survey and a provider focus group (5 primary care physicians and 1 diabetes educator). In addition, we identified best evidence from a systematic review of quality improvement initiatives in diabetes. This information was reviewed at a multistakeholder workshop where potential quality improvement initiatives were considered at various service levels. RESULTS: A pilot survey involving 59 patients with diabetes and a focus group of primary care and allied health care providers identified several important barriers to optimal outcomes in diabetes care, including patient-level financial barriers to care and difficulty navigating the health system. Our collaborative discussion using the knowledge-to-action cycle prioritized feasible, evidence-based interventions to improve outcomes for patients with diabetes, including enabling care by allied health care providers and creating clear care maps and processes for system navigation. INTERPRETATION: We identified important barriers to achieving optimal outcomes in diabetes that may be overcome through the use of evidence-based quality improvement interventions. As recommended within the knowledge-to-action cycle, future research is required to determine whether program implementation improves outcomes and is cost-effective.
Authors: David J T Campbell; Peter Sargious; Richard Lewanczuk; Kerry McBrien; Marcello Tonelli; Brenda Hemmelgarn; Braden Manns Journal: Can Fam Physician Date: 2013-02 Impact factor: 3.275
Authors: Peter Gaede; Pernille Vedel; Nicolai Larsen; Gunnar V H Jensen; Hans-Henrik Parving; Oluf Pedersen Journal: N Engl J Med Date: 2003-01-30 Impact factor: 91.245
Authors: A Austvoll-Dahlgren; M Aaserud; G Vist; C Ramsay; A D Oxman; H Sturm; J P Kösters; A Vernby Journal: Cochrane Database Syst Rev Date: 2008-01-23
Authors: Maria Levis-Peralta; Maria Del Rosario González; Renée Stalmeijer; Diana Dolmans; Jascha de Nooijer Journal: Front Endocrinol (Lausanne) Date: 2020-07-15 Impact factor: 5.555