Study Identifies Successful Strategies for Improving Diabetes Care Delivery

Kevin A. Peterson, MD, MPH

Credit: University of Minnesota

New research identified common, successful strategies to manage change and quality improvement in diabetes care across high-performing practices in the primary care setting.¹

According to the analysis, shared change management strategies, including the standardization of the care process and enhancement of care teams, and top management themes, including proactive care and improved patient relationships, were similar across 10 primary care practices.

“The identified change management strategies are not goals to accomplish and do not lend themselves to the establishment of simple metrics; however, together they provide a perspective for how successful practices manage change during performance improvement,” wrote the investigative team, led by Kevin A. Peterson, MD, MPH, department of family medicine and community health, University of Minnesota.

Adjustments to existing care management strategies can be essential to improve the quality of care but are often disruptive to the already hectic clinical environment. Improvements to diabetes care delivery are a common focus in the primary care setting. In particular, successful strategies for diabetes in primary care help inform the implementation of effective management processes across a variety of chronic diseases.

A previous report from Peterson and colleagues suggested care processes differ between low-performing and high-performing practices in Minnesota.² The team suggested the effective adoption of a care management process could be a differentiating characteristic of high-performing practices. This qualitative analysis assessed strategies used by the highest-performing primary care practices to determine how these practices managed change in diabetes care.¹

Investigators selected 330 primary care practices completing the Physician Practice Connections Readiness Survey (PPC-RS) survey in Minnesota and submitting annual diabetes performance data in 2017 and 2019. A patient was considered to have received optimal care, if they achieved blood glucose control, and blood pressure control, underwent guideline-based statin use and antiplatelet drug use, and were a nonsmoker. Practice performance was measured according to the National Quality Forum-Endorsed Maintenance Standard Optimal Diabetes Care (NQF-ODC).

Practices from the upper quartile of the ODC performance in 2017 and 2019 were identified and ranked according to the annual percentage improvement in ODC score. Beginning with the highest-performing practices, investigators interviewed practice leaders to identify the most effective strategies for managing change. Saturation occurred in the analysis when 2 practices were interviewed sequentially, and no new strategies were identified.

A total of 13 practices were approached and 10 agreed to the interviews. The average ODC performance for these practices was 56%, compared to 48.4% for the entire cohort. Overall, the investigators identified 199 key comments over the 10 interviews, representing 48 key care management concepts.

The analysis categorized strategic approaches into 13 distinct change management strategies. A total of 9 change management strategies were considered important by 5 or more practices and highlighted by the investigative team. Although the same strategies were commonly identified, investigators noted no single practice identified all 9 strategies.

The 9 change management strategies included:

1. Standardizing the care process
2. Performance awareness
3. Enhancing care teams
4. Healthcare organization participation
5. Improving reporting systems
6. Engaging staff and clinicians
7. Accountability for tasks
8. Engaging leadership
9. Tracking change

The analysis also identified shared perspectives across surveyed practices on what care processes should be targeted. The top 3 main care management themes in most practices included proactive care, pre-visit planning, and improving patient relationships. Barriers to performance improvement were infrequently reported by high-performing practices, with no single barrier noted by more than 4 practices.

Peterson and colleagues suggested a review of these perspectives could benefit practices in identifying strengths and weaknesses in their approach to change management. In addition, they noted these highlighted strategies could be applicable across a variety of improvement approaches and chronic diseases.

“Because the strategies identified by these practices were not developed from a particular approach to improvement, they suggest an approach to change management that potentially has broader applicability beyond diabetes improvement,” investigators wrote.

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