Triggering change in diabetes care delivery in general practice: a qualitative evaluation approach using the clinical microsystem framework

Janamian, Tina, Crossland, Lisa J., Jackson, Claire and Morcom, Jenny (2014) Triggering change in diabetes care delivery in general practice: a qualitative evaluation approach using the clinical microsystem framework. BMC Family Practice, 15 1: 32.1-32.6. doi:10.1186/1471-2296-15-32


Author Janamian, Tina
Crossland, Lisa J.
Jackson, Claire
Morcom, Jenny
Title Triggering change in diabetes care delivery in general practice: a qualitative evaluation approach using the clinical microsystem framework
Journal name BMC Family Practice   Check publisher's open access policy
ISSN 1471-2296
Publication date 2014-02-13
Sub-type Article (original research)
DOI 10.1186/1471-2296-15-32
Open Access Status DOI
Volume 15
Issue 1
Start page 32.1
End page 32.6
Total pages 6
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2015
Language eng
Subject 2714 Family Practice
Formatted abstract
Background: In 2008, the Sunshine Coast Division of General Practice (SCDGP) in Queensland, Australia initiated a highly successful Improved Diabetes Management (IDM) program with general practices in a regional area. The IDM program was evaluated against the 10 elements of a high functioning clinical microsystem framework as identified by Nelson et al. (2007) in order to determine key factors contributing to the successful adoption and uptake of the program in participating general practices.

Methods: The evaluation focussed on in-depth key informant interviews with 10 SCDGP staff and general practitioners (GPs) involved in the IDM program. A thematic analysis was undertaken and common emergent themes were reviewed against the 10 elements of high performing clinical microsystem.

Results: While all aspects of the clinical microsystem approach appeared effective in the design, implementation and adoption of the IDM program, several characteristics were crucial. The identification of champions of change in both the division and participating practices, the celebration of positive achievements and the use 'real data' from practices to demonstrate improved health outcomes for patients from the practice were instrumental in motivating participating GPs to both implement and sustain changes in their diabetes care delivery.

Conclusion: In designing and redesigning health care, the clinical microsystems approach offers a pathway for the effective uptake of innovation in Australian primary health care; a means of integrating structure, process and outcomes of a care framework for reviewing improvements in the health care delivery process and could lead to improvements in patient health outcomes.
Keyword Clinical microsystems
Quality improvement
Diabetes mellitus
Chronic disease management
Health services research
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Discipline of General Practice Publications
Official 2015 Collection
School of Medicine Publications
 
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