title: Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care.
abstract: BACKGROUND
  Type 2 diabetes is an increasingly prevalent chronic illness and is an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of the primary care team. Studies of the quality of care for patients with diabetes suggest less than optimum care in a number of areas.
  
  
  OBJECTIVE
  The aim of this study is to improve the quality of care for patients with diabetes cared for in primary care in the UK by identifying individual, team, and organisational factors that predict the implementation of best practice.
  
  
  METHODS
  Participants will be clinical and non-clinical staff within 100 general practices sampled from practices who are members of the MRC General Practice Research Framework. Self-completion questionnaires will be developed to measure the attributes of individual health care professionals, primary care teams (including both clinical and non-clinical staff), and their organisation in primary care. Questionnaires will be administered using postal survey methods. A range of validated theories will be used as a framework for the questionnaire instruments. Data relating to a range of dimensions of the organisational structure of primary care will be collected via a telephone interview at each practice using a structured interview schedule. We will also collect data relating to the processes of care, markers of biochemical control, and relevant indicator scores from the quality and outcomes framework (QOF). Process data (as a proxy indicator of clinical behaviours) will be collected from practice databases and via a postal questionnaire survey of a random selection of patients from each practice. Levels of biochemical control will be extracted from practice databases. A series of analyses will be conducted to relate the individual, team, and organisational data to the process, control, and QOF data to identify configurations associated with high quality care.
  
  
  BACKGROUND
  UKCRN ref:DRN120 (ICPD).
authors.affiliation: Institute of Health and Society, University of Newcastle upon Tyne, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK. martin.eccles@ncl.ac.uk
authors.forename: Martin P
authors.initials: MP
authors.lastname: Eccles
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawthorne
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.forename: Margaret
authors.initials: M
authors.lastname: Hunter
authors.forename: Nick
authors.initials: N
authors.lastname: Steen
authors.forename: Jill
authors.initials: J
authors.lastname: Francis
authors.forename: Susan
authors.initials: S
authors.lastname: Hrisos
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw