Identifying strategies to improve diabetes care in Alberta, Canada, using the knowledge-to-action cycle

Manns, Braden; Braun, Theodore E. D.; Edwards, Alun; Grimshaw, Jeremy; Hemmelgarn, Brenda R.; Husereau, Don; Ivers, Noah; Johnson, Jeff; Long, Steve; McBrien, Kerry; Naugler, Christopher; Sargious, Peter; Straus, Sharon E.; Tricco, Andrea C.; Yu, Catherine

doi:10.9778/cmajo.20130024

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…The action cycle is the process of translating knowledge into practice comprising seven components: (1) identifying the problem, (2) adapting knowledge, (3) assessing barriers, (4) implementing, (5) monitoring, (6) evaluating, and (7) sustaining [6]. The application of this framework has significantly and positively influenced clinical practice and patient outcomes [6][7][8][9][10]. To our knowledge [11], there are few reports on the application of the KTA framework in China; use of the framework for joint arthroplasty patients has not been explored.…”

Section: Introductionmentioning

confidence: 99%

Using the knowledge-to-action framework with joint arthroplasty patients to improve the quality of care transition: a quasi-experimental study

Xu¹,

Li²,

Zhao³

et al. 2020

J Orthop Surg Res

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Background: Total joint arthroplasty is a mature and effective treatment for end-stage osteoarthritis. Assisting patients in completing the transition of the perioperative period and improving their satisfaction are important aspects of quality of care. This study aimed to investigate an intervention to improve the quality of care transition for joint arthroplasty patients informed by the knowledge-to-action (KTA) framework. Methods: In this quasi-experimental study, a total of 160 patients who underwent joint arthroplasty at a tertiary hospital from September to November 2018 and January to March 2019 were selected as participants using convenience sampling. The control group received routine medical care, while the observation group received medical care based on the KTA framework. Transitional care quality was assessed by the Care Transition Measure (CTM), with follow-up 1 week after discharge. Results: The observation group fared significantly better than the control group on general self-care preparation and written plan dimensions, as well as the quality of care transition. There was no significant difference in doctorpatient communication or health monitoring. Conclusions: The KTA framework provides a logical, valuable tool for clinical work. Using the KTA framework for joint arthroplasty patients helps to improve the quality of care transition, which is worth promoting.

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Section: Introductionmentioning

confidence: 99%

Using the knowledge-to-action framework with joint arthroplasty patients to improve the quality of care transition: a quasi-experimental study

Xu¹,

Li²,

Zhao³

et al. 2020

J Orthop Surg Res

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“…The studies included in this review spanned the USA, Canada, Europe (UK and Netherlands), Asia (China), and the Middle East (Oman). Methodologically, these studies were principally qualitative ( 7 , 35 – 38 , 40 , 41 , 44 , 47 , 49 , 51 , 54 – 56 ), with a few using mixed methods ( 6 , 39 , 42 , 45 , 48 , 50 , 53 ) and two randomized control trials ( 28 , 46 ). Furthermore, two reviews ( 24 , 52 ) were included about diabetes that provided some insights into the organizational context necessary for team-based care, although they were not specifically about organizational conditions.…”

Section: Resultsmentioning

confidence: 99%

“…Although most studies focused their analysis on one of these levels, various studies blurred the boundaries between the levels. It is noteworthy that these studies were mostly qualitative in which the focus of study was the team (micro-level) and the team members identified the other levels ( 41 , 53 ), even though they do not exercise direct control over these factors. Further research also needs to go into understanding how decision-making plays a role in the organizational conditions and which factors in each level have different effects on TBC for diabetic patients.…”

Section: Resultsmentioning

confidence: 99%

“…This is an important distinction in the study of organizational conditions that can help explain why similar interventions may not have the same results ( 28 ). For example, the financial implications of TBC are an often-cited in the literature as a barrier to TBC ( 7 , 41 , 42 ), but organization using different payment models have been able to achieve TBC. An analysis by organizational level can help explain if changes in financial implications at the Macro, Meso, or Micro-level are required or if there is a necessary alignment between them which impacts TBC.…”

Section: Discussionmentioning

confidence: 99%

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Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients—A Scoping Review

et al. 2020

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Background: Team-based care models (TBC) have demonstrated effectiveness to improve health outcomes for vulnerable diabetes patients but have proven difficult to implement in low income settings. Organizational conditions have been identified as influential on the implementation of TBC. This scoping review aims to answer the question: What is known from the scientific literature about how organizational conditions enable or inhibit TBC for diabetic patients in primary care settings, particularly settings that serve low-income patients? Methods: A scoping review study design was selected to identify key concepts and research gaps in the literature related to the impact of organizational conditions on TBC. Twenty-six articles were finally selected and included in this review. This scoping review was carried out following a directed content analysis approach. Results: While it is assumed that trained health professionals from diverse disciplines working in a common setting will sort it out and work as a team, co-location, and health professions education alone do not improve patient outcomes for diabetic patients. Health system, organization, and/or team level factors affect the way in which members of a care team, including patients and caregivers, collaborate to improve health outcomes. Organizational factors span across seven categories: governance and policies, structure and process, workplace culture, resources, team skills and knowledge, financial implications, and technology. These organizational factors are cited throughout the literature as important to TBC, however, research on the organizational conditions that enable and inhibit TBC for diabetic patients is extremely limited. Dispersed organizational factors are cited throughout the literature, but only one study specifically assesses the effect of organizational factors on TBC. Thematic analysis was used to categorize organizational factors in the literature about TBC and diabetes and a framework for analysis and definitions for key terms is presented. Conclusions: The review identified significant gaps in the literature relating to the study of organizational conditions that enable or inhibit TBC for low-income patients with diabetes. Efforts need to be carried out to establish unifying terminology and frameworks across the field to help explain the relationship between organizational conditions and TBC for diabetes. Gaps in the literature include research be based on organizational theories, research carried out in low-income settings and low and middle income countries, research explaining the difference between the organizational conditions that impact the implementation of TBC vs. maintaining or sustaining TBC and the interaction between organizational factors at the micro, meso and macro level and their impact on TBC. Few studies include information on patient outcomes, and fewer include information on low income settings. Further research is necessary on th...

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“…Even though, system navigation strategies have not been amply explored in Canada, there is evidence of its effectiveness to improve health outcomes of immigrants living with chronic diseases in the United States [ 57 ]. In Alberta, it has been recognized that difficulties navigating the health system is one of the main barriers to improve the health of people living with diabetes [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

“There are still a lot of things that I need”: a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic

Loyola‐Sánchez

Peláez‐Ballestas

Crowshoe

et al. 2020

BMC Health Serv Res

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Background Arthritis is a highly prevalent disease and leading cause of disability in the Indigenous population. A novel model of care consisting of a rheumatology outreach clinic in an on-reserve primary healthcare center has provided service to an Indigenous community in Southern Alberta since 2010. Despite quality assessments suggesting this model of care improves accessibility and is effective in meeting treatment targets, substantial improvements in patient-reported outcomes have not been realized. Therefore, the objective of this study was to explore the experiences of Indigenous persons with arthritis and healthcare providers involved in this model of care to inform the development of health service improvements that enhance patient outcomes. Methods This was a narrative-based qualitative study involving a purposeful sample of 32 individuals involved in the Indigenous rheumatology model of care. In-depth interviews were conducted to elicit experiences with the existing model of care and to encourage reflections on opportunities to improve it. A two-stage analysis was conducted. The first stage aimed to produce a narrative synthesis of concepts through a dialogical method comparing people with arthritis and health providers’ narratives. The second stage involved a collective effort to synthesize concepts and propose specific recommendations to improve the quality of the current model of care. Triangulation, through participant checking and discussion among researchers, was used to increase the validity of the final recommendations. Results Ten Indigenous people with arthritis lived experience, 14 health providers and 8 administrative staff were interviewed. One main overarching theme was identified, which reflected the need to provide services that improve people’s physical and mental functioning. Further, the following specific recommendations were identified: 1) enhancing patient-provider communication, 2) improving the continuity of the healthcare service, 3) increasing community awareness about the presence and negative impact of arthritis, and 4) increasing peer connections and support among people living with arthritis. Conclusions Improving the quality of the current Indigenous rheumatology model of care requires implementing strategies that improve functioning, patient-provider communication, continuity of care, community awareness and peer support. A community-based provider who supports people while navigating health services could facilitate the implementation of these strategies.

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Identifying strategies to improve diabetes care in Alberta, Canada, using the knowledge-to-action cycle

Cited by 7 publications

References 18 publications

Using the knowledge-to-action framework with joint arthroplasty patients to improve the quality of care transition: a quasi-experimental study

Using the knowledge-to-action framework with joint arthroplasty patients to improve the quality of care transition: a quasi-experimental study

Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients—A Scoping Review

“There are still a lot of things that I need”: a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic

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