This qualitative study considers how the strategies used by high-performing primary care practices to improve diabetes care might play a role in successfully managing practice change. The research team conducted semistructured interviews at 10 Minnesota primary care practices (rural and urban) ranked in the top quartile of diabetes care improvement per their Optimal Diabetes Care (ODC) scores. (Minnesota's ODC scores are calculated based on mandatory reporting of performance data.) They asked three questions to prompt discussions of how practice leaders managed change:
1) What changes do you think contributed most to that improvement in ODC scores?
2) How did you implement those changes? Did you use any particular strategies?
3) Were there any other factors that contributed to your improvement?
What we know: Improving diabetes outcomes in primary care depends on successfully implementing effective changes to diabetes care. However, changes can be disruptive in a busy practice, and problems with clinician engagement, staff education, or support from leadership can render changes ineffective and compromise results. Although differences in care management processes (CMPs, specific activities performed with the goal of providing high-quality care) used by high- and low-performing practices have been reported, how high- and low-performing practices adopt and manage CMPs may be another differentiating factor.
What this study adds: The research team found that high-performing primary care practices tend to use similar strategies to manage change and quality improvement in caring for patients with diabetes. Nine common strategies emerged: 1) standardizing the care process, 2) performance awareness, 3) enhancing care teams, 4) health care organization participation, 5) improving reporting systems, 6) engaging staff and clinicians, 7) accountability for tasks, 8) engaging leadership, and 9) tracking change. The three top management themes identified by most practices were proactive care, pre-visit planning, and improving patient relationships. Primary care practices may be able to improve care for chronic conditions in addition to diabetes by adopting similar strategies.