Researchers Identify Key Differences in Diabetes Care Quality Between Clinics

The main difference between high- and low-performing diabetes care clinics is the adoption of approaches aimed at leveraging data-driven proactive patient outreach as a tool to intensify treatment, according to a recent study.

The investigators said that physicians should consider the results of the study, published in The Annals of Family Medicine, and the potential value that incorporating a paradigm like this can have on diabetes care.

“Perhaps there are other stages in the development of innovations for practice transformation; in the meantime, these findings should be considered by leaders interested in improving care for patients with diabetes and other chronic conditions,” wrote the investigators.

A previous study found that the measures of diabetes care outcomes did not improve from 2005 to 2016, despite a significant rise in national campaigns to improve diabetes control and an overall improvement in treatment options.

However, the percentage of Minnesota patients with diabetes who achieved optimal care increased from 12% to 45% between 2004 and 2017, differing from the rest of the nation, which plateaued at 23% from 2013 to 2016. The investigators attributed the variance to an emphasis on performance monitoring and public reporting.

In light of that study, researchers of the present analysis used quantitative data to determine what factors determine whether a Minnesota clinic are considered high- or low-performing. They distributed surveys to primary care clinics that participated in the previous study, of which 416 completed them. Respondents were asked to report whether care management processes were present and rate their clinic’s priority for improving diabetes care in the next year.

After returning the survey, clinic leaders were asked to participate in a 20-to-30-minute interview to discuss their approaches to diabetes care.

The clinics were identified as high-, middle-, or low-performing based on their scores from the Minnesota Community Measurement. From the survey results, the investigators identified 10 themes that offered insight into the factors and methods characterizing the performance groups:

1. Proactive care is a major difference between performance groups.
2. Visit-based care management processes are needed yet are insufficient for highest-performing clinics.
3. Facilitating factor must be present in addition to care delivery strategies.
4. A variety of roles are important for expanded care teams.
5. Use of community resources and action on social determinants were not described often.
6. Being a part of a large system was considered helpful.
7. It’s helpful to not have clinic-related or organizational barriers.
8. Clinic performance awareness is important.
9. Patients were rarely blamed for deficiencies in performance rates.
10. Establishing trust and good relationships between clinic staff and patients is critical.

The main difference between groups was that high-performing clinics were much more likely to report using proactive care compared with low-performing clinics, who either didn’t mention those strategies or cited barriers to implementing them. Middle-performing clinics mostly reported that they just starting to adopt proactive approaches or viewed them as a wish.

High-performing clinics relied on timely and accurate reports to identify individual patients that were falling behind treatment goals and address their need without waiting for them to ask or come in for a scheduled appointment.

The investigators also said that they were surprised with how few comments they received, across all performance groups, regarding effective care management processes, with the exception of distributing diabetes education.

The middle-performing group had the most comments regarding effective care management processes and had the highest scores on the survey of diabetes process, suggesting, “that a clinic can obtain good performance by implementing these processes, but to break through to high performance, a paradigm shift is needed to add proactive care,” wrote the researchers.

The investigators identified the small group of clinics used, only sampling from one state, including few low-performing clinics, and indirect measurements of socioeconomic status as study limitations. They said that their results should be considered preliminary and that future studies confirming the results need to be conducted.

Reference

Solberg LI, Peterson KA, Fu H, Eder M, Jacobson R, Carlin CS. Strategies and factors associated with top performance in primary care for diabetes: insights from a mixed methods study. Ann. Fam. Med. March 2021;19(2):110-116. doi:10.1370/afm.2646