Features of primary health care teams associated with successful quality improvement of diabetes care: a qualitative study

Stevenson, Keith; Baker, Richard; Farooqi, Azhar; Sorrie, Roz; Khunti, Kamlesh

doi:10.1093/fampra/18.1.21

Cited by 87 publications

(57 citation statements)

References 8 publications

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“…10,11 Recent studies suggest that the way chronic disease management is delivered in general practice is highly infl uenced by organizational factors. 12,13 Various studies have suggested that highquality chronic disease management can be promoted by fi nancial incentives, capitated payment structures, improved Internet technology infrastructure, and the wider use of nonmedical health care professionals. [14][15][16] In Canada, several provinces are in the process of redesigning their primary care system with the clear purpose of improving chronic illness care.…”

Section: Introductionmentioning

confidence: 99%

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

Russell¹,

Dahrouge²,

Hogg³

et al. 2009

The Annals of Family Medicine

156

143

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PURPOSE New approaches to chronic disease management emphasize the need to improve the delivery of primary care services to meet the needs of chronically ill patients. This study (1) assessed whether chronic disease management differed among 4 models of primary health care delivery and (2) identifi ed which practice organizational factors were independently associated with high-quality care. METHODSWe undertook a cross-sectional survey with nested qualitative case studies (2 practices per model) in 137 randomly selected primary care practices from 4 delivery models in Ontario Canada: fee for service, capitation, blended payment, and community health centers (CHCs). Practice and clinician surveys were based on the Primary Care Assessment Tool. A chart audit assessed evidence-based care delivery for patients with diabetes, congestive heart failure, and coronary artery disease. Intermediate outcomes were calculated for patients with diabetes and hypertension. Multiple linear regression identifi ed those organizational factors independently associated with chronic disease management. RESULTSChronic disease management was superior in CHCs. Clinicians in CHCs found it easier than those in the other models to promote high-quality care through longer consultations and interprofessional collaboration. Across the whole sample and independent of model, high-quality chronic disease management was associated with the presence of a nurse-practitioner. It was also associated with lower patient-family physician ratios and when practices had 4 or fewer full-time-equivalent family physicians. CONCLUSIONSThe study adds to the literature supporting the value of nursepractitioners within primary care teams and validates the contributions of Ontario's CHCs. Our observation that quality of care decreased in larger, busier practices suggests that moves toward larger practices and greater patientphysician ratios may have unanticipated negative effects on processes of care quality. 2009;7:309-318. doi:10.1370/afm.982. Ann Fam Med INTRODUCTIONC hronic health conditions are a substantial challenge to global health.1 By 2020 they will account for 73% of all deaths and 60% of the global burden of disease.2-5 Canada's experience matches that of much of the developed world, where in the next decade deaths caused by chronic diseases will increase by 15%. 6 The growing burden of chronic diseases threatens the sustainability of health care systems. 7,8 In the United States, for example, the annual economic effect on the US economy of the most common chronic diseases is more than $1 trillion and could reach nearly $6 trillion by the middle of the century. 4 Canada stands to lose $9 billion in the next decade from premature deaths caused by heart disease, stroke, and diabetes. Policy makers have become increasingly interested in the potential of high-quality primary care to help deal with the chronic disease challenge. Primary care is well positioned to have an important impact on outcomes of care for patients with chronic conditions. 9 The...

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Section: Introductionmentioning

confidence: 99%

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

Russell¹,

Dahrouge²,

Hogg³

et al. 2009

The Annals of Family Medicine

156

143

View full text Add to dashboard Cite

show abstract

“…2,3 High-functioning primary care teams have higher patient satisfaction, higher job satisfaction, and lower staff burnout, which are associated with higher quality of care. [4][5][6][7][8][9][10][11][12] Primary care teams offer a unique opportunity to improve quality of care and lower medical costs for patients with cardiovascular disease. Through interdependent activities, team members provide support and share respon-sibilities for patient care (eg, adherence support, selfmanagement support, patient follow-up, medication management).…”

mentioning

confidence: 99%

“…A primary care team's relationships could be as fundamental to the team's delivery of high-quality care at lower cost as its reliance on medical technology, informational technology, and other infrastructural components. 8,19,20 Our study investigated which aspects of primary care team social networks are associated with higher quality of care and lower cost for patients with cardiovascular disease. For the purpose of this study, social networks are defined as "the pattern of friendship, advice, communication and support that exists among members of a social system" 21 (ie, team members).…”

mentioning

confidence: 99%

Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease

Mundt

Gilchrist

Fleming

et al. 2015

The Annals of Family Medicine

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PURPOSE Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease.METHODS Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. CONCLUSIONS Primary care teams that are more interconnected and less centralized and that have a shared team vision are better positioned to deliver highquality cardiovascular disease care at a lower cost. RESULTS

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“…TeamSTEPPS data illustrates that collaborative work improves continuity of care, access to care, and patient satisfaction (Stevenson et al, 2001). Studies also show patients believe that they are receiving a higher quality of care when teamwork is prevalent among health care workers (Campbell et al, 2001;Weaver et al, 2010).…”

Section: Linking Evidence To Practicementioning

confidence: 99%

Improving Interdisciplinary Relationships in Primary Care with the Implementation of TeamSTEPPS

Siddons

2016

IJPS

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A major challenge in healthcare is lack of interdisciplinary collaboration (O’Daniel & Rosenstein, 2008). The Institute of Medicine report, To Err is Human: Building a Safer Health System (1999), shows that errors often occur due to lapses in partnership and communication. This article describes the implementation of TeamSTEPPS, an evidence-based tool for optimizing staff relationships and partnership, in a clinic in which a change in the care model had affected interprofessional collaboration and teamwork, threatening healthcare outcomes and staff engagement. The implementation of TeamSTEPPS, customized using elements of IDEO’s (2015) Human-Centered Design, shifted the culture of the clinic towards partnership, resulting in improved staff perceptions of teamwork and statistically significant improvements in the quality of patient care.

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Features of primary health care teams associated with successful quality improvement of diabetes care: a qualitative study

Cited by 87 publications

References 8 publications

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

Managing Chronic Disease in Ontario Primary Care: The Impact of Organizational Factors

Effects of Primary Care Team Social Networks on Quality of Care and Costs for Patients With Cardiovascular Disease

Improving Interdisciplinary Relationships in Primary Care with the Implementation of TeamSTEPPS

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