SIIReN - System Integration & Innovation Research Network

Primary Health Care System

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“Can quality improvement initiatives improve diabetes care?
The partnerships for health project"

Presenters: Stewart Harris, Jann Paquette-Warren, The University of Western Ontario
October 20, 2011



The rapid increase in the prevalence of diabetes and related healthcare costs, the complex needs of patients with chronic diseases, the challenges associated with establishing effective partnerships to enhance care, and the difficulties related to improving overall efficiency of care using Electronic Medical Records (EMRs) has fueled the development of initiatives to improve diabetes management in primary care.

The Partnerships for Health (PFH) project made use of the Chronic Disease Prevention and Management Framework, Model for Improvement and learning collaborative methodologies to improve diabetes care in primary care sites in Southwestern Ontario by enhancing coordination of care among primary care and community providers, and by providing IT training and support.

The results of an external comprehensive evaluation of the project revealed an overall improvement in team functioning and identified multiple factors that influence the establishment of partnerships. Beyond team functioning, the results showed a significant improvement in adherence to best practice guidelines that translated into significant improvement in clinical outcomes (BP, LDL, HbA1c), particularly for patients who were out of target at baseline. Many participants attributed the success of the project to the opportunity to have dedicated time off-site to:

  1. Learn more about diabetes and diabetes care,
  2. Work as a team,
  3. Network with community partners and other primary care teams, and
  4. Learn and have support related to the best use technology to facilitate quality improvement and efficiency of care.

By the end of the project participants described their EMR as easier to use and as positively influencing work performance, but they did not perceive an overall improvement in the quality of the information or satisfaction with the EMR.

Results suggest that participation in quality improvement initiatives like PFH can lead to improved diabetes clinical processes and outcomes one year post-intervention and that the opportunity to come together with potential partners, assess patients’ needs, individual roles and possible contributions, can facilitate system-level change leading to improved integration of services. Lastly, the inclusion of IT training and support in quality improvement initiatives appears to be an essential component, but the results highlight the need for more work to improve data quality and satisfaction with EMRs in primary care. Future studies are needed to assess the sustainability and spread of this success.

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