The rigorous design and methodology of the QIIP-LC evaluation utilizing a control group is one of the most significant efforts thus far to demonstrate the impact of a QI program in PHC, with improvements over time in both QIIP and control groups offering a likely explanation for the lack of statistically significant primary outcomes. Team functioning was a key success, with team-based chronic care highlighted as pivotal for improved health outcomes. Policy makers should strive to endorse QI programs with proven success through rigorous evaluation to ensure evidence-based healthcare policy and funding.
Process evaluations assess program structures and implementation processes so that outcomes can be accurately interpreted. This article reports the results of a process evaluation of Partnerships for Health, an initiative targeting interprofessional primary healthcare teams to improve chronic care in Southwestern Ontario, Canada. Program documentation, participant observation, and in-depth interviews were used to capture details about the program structure, implementation process, and experience of implementers and participants. Results suggest that the intended program was modified during implementation to better meet the needs of participants and to overcome participation barriers. Elements of program activities perceived as most effective included series of off-site learning/classroom sessions, practice-based/workplace information-technology (IT) support, and practice coaching because they provided: dedicated time to learn how to improve chronic care; team-building/networking within and across teams; hands-on IT training/guidance; and flexibility to meet individual practice needs. This process evaluation highlighted key program activities that were essential to the continuing education (CE) of interprofessional primary healthcare teams as they attempted to transform primary healthcare to improve chronic care.
Objective: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits.Design: Qualitative method of focus groups. SettingyParticipants:The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. Method:Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis.Main findings: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communicationycollaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. Conclusion:Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting.
Many investments have been made to help address the rising prevalence and associated costs of diabetes, but there has been minimal evaluation to assess their value. A comprehensive literature review and fi ve expert committee meetings were conducted to iteratively conceptualize and develop a Diabetes Evaluation Framework (DEFINE). Building on existing frameworks, DEFINE provides an evidence-based approach for evaluating diabetes. Th e framework is focused on guiding evaluation, building robust evidence, and fostering knowledge translation. DEFINE promotes comprehensive evaluation of initiatives targeting diabetes prevention and management, and will facilitate policy innovations to reduce the burden of diabetes. Résumé : Plusieurs investissements ont été déployés pour lutter contre la prévalence croissante du diabète et ses coûts aff érents, mais peu d' eff orts pour évaluer leurs bénéfi ces. Une recension exhaustive de la littérature et cinq réunions d'un comité d' experts ont eu lieu pour concevoir et développer de façon itérative uncadre d' évaluation du diabète. Baptisé DEFINE, ce cadre basé sur des modèles existants s' avère une méthode fondée sur des données probantes pour évaluer le diabète. Le cadre vise à orienter l' évaluation, établir des données probantes, et faciliter le transfert de connaissances. DEFINE vise la promotion de l' évaluation compréhensive des initiatives ciblant la prévention et la gestion du diabète et facilite les innovations politiques aidant à réduire le fardeau du diabète.
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