title: Results of a mixed-methods evaluation of partnerships for health: a quality improvement initiative for diabetes care.
abstract: OBJECTIVE
  Quality improvement (QI) initiatives have been implemented to facilitate transition to a chronic disease management approach in primary health care. However, the effect of QI initiatives on diabetes clinical processes and outcomes remains unclear. This article reports the effect of Partnerships for Health, a QI program implemented in Southwestern Ontario, Canada, on diabetes clinical process and outcome measures and describes program participants' views of elements that influenced their ability to reach desired improvements.
  
  
  METHODS
  Part of an external, concurrent, comprehensive, mixed-methods evaluation of Partnerships for Health, a before/after audit of 30 charts of patient of program physicians (n = 35) and semistructured interviews with program participants (physicians and allied health providers) were conducted.
  
  
  RESULTS
  The proportion of patients (n = 998) with a documented test/examination for the following clinical processes significantly improved (P ≤ .005): glycosylated hemoglobin (A1c), cholesterol, albumin-to-creatinine ratio, serum creatinine, glomerular filtration rate, electrocardiogram, foot/eye/neuropathy examination, body mass index, waist circumference, and depression screening. Data showed intensification of treatment and significant improvement in the number of patients at target for low-density lipoprotein (LDL) and blood pressure (BP) (P ≤ .001). Mean LDL and BP values decreased significantly (P ≤ .01), and an analysis of patients above glycemic targets (A1c >7% at baseline) showed a significant decrease in mean A1c values (P ≤ .01). Interview participants (n = 55) described using a team approach, improved collaborative and proactive care through better tracking of patient data, and increased patient involvement as elements that positively influenced clinical processes and outcomes.
  
  
  CONCLUSIONS
  QI initiatives like Partnerships for Health can result in improved diabetes clinical process and outcome measures in primary health care.
authors.affiliation: the Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; and Renison University College, The University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Stewart
authors.initials: S
authors.lastname: Harris
authors.forename: Jann
authors.initials: J
authors.lastname: Paquette-Warren
authors.forename: Sharon
authors.initials: S
authors.lastname: Roberts
authors.forename: Meghan
authors.initials: M
authors.lastname: Fournie
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
authors.forename: Bridget L
authors.initials: BL
authors.lastname: Ryan
authors.forename: Cathy
authors.initials: C
authors.lastname: Thorpe
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Terry
authors.forename: Judith Belle
authors.initials: JB
authors.lastname: Brown
authors.forename: Moira
authors.initials: M
authors.lastname: Stewart
authors.forename: Susan
authors.initials: S
authors.lastname: Webster-Bogaert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D054869:Clinical Audit / Q000379:methods*; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010317:Partnership Practice / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes Mellitus; Health Care Team; Primary Health Care; Quality Improvement