title: High quality diabetes care: testing the effectiveness of strategies of regional implementation teams.
abstract: OBJECTIVE
  The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes patients.
  
  
  METHODS
  The study was conducted in a major health maintenance organization (HMO) that provides care for 70 per cent of Israel's diabetes patients. A sequential mixed model design, combining qualitative and quantitative methods was employed. In-depth interviews were conducted with members of six regional implementation teams, each responsible for the care of 25,000-34,000 diabetic patients. Content analysis of the interviews revealed that teams employed four key strategies: task-interdependence, goal-interdependence, reliance on top-down standardised processes and team-learning. These strategies were used to predict the mean percentage performance of eight evidence-based indicators of diabetes care: percentage of patients with HbA1c < 7 per cent, blood pressure < or = 130/80 and cholesterol < or = 100; and performance of: HbA1c tests, LDL cholesterol tests, blood pressure measurements, urine protein tests, and ophthalmic examinations.
  
  
  RESULTS
  Teams were found to vary in their use of the four strategies. Mixed linear models analysis indicated that type of indicator (simple process, compound process, and outcome) and goal interdependence were significantly linked to team effectiveness. For simple-process indicators, reliance on top-down standardised processes led to team effectiveness, but for outcome measures this strategy was ineffective, and even counter-effective. For outcome measures, team-learning was more beneficial.
  
  
  CONCLUSIONS
  The findings have implications for the management of chronic diseases.
  
  
  CONCLUSIONS
  The advantage of allowing team members flexibility in the choice of the best work strategy to attain high quality diabetes care is attested.
authors: University of Haifa, Haifa, Israel. anatdz@research.haifa.ac.il
authors: Anat
authors: A
authors: Drach-Zahavy
authors: Efrat
authors: E
authors: Shadmi
authors: Anat
authors: A
authors: Freund
authors: Margalit
authors: M
authors: Goldfracht
mesh_terms: D048909:Diabetes Complications / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000628:therapy*; D006279:Health Maintenance Organizations; D006801:Humans; D033183:Interdisciplinary Communication; D007557:Israel; D008137:Longitudinal Studies; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team