title: Identifying strategies to improve diabetes care in Alberta, Canada, using the knowledge-to-action cycle.
abstract: BACKGROUND
  Strategic clinical networks, a recent development in the health system in Alberta, have been charged with bringing together front-line clinicians, researchers and policy-makers to identify variation in clinical care, and to propose standards, pathways and innovative solutions to improve access and quality of care. Here, we describe a collaborative workshop held between researchers and the Obesity, Diabetes and Nutrition Strategic Clinical Network to describe barriers to and facilitators of care for people with diabetes and to identify quality improvement interventions that should be prioritized.
  
  
  METHODS
  Through collaboration between health researchers and the strategic clinical network, and using principles of the knowledge-to-action cycle, we identified barriers to and facilitators of diabetes care using data from a patient survey and a provider focus group (5 primary care physicians and 1 diabetes educator). In addition, we identified best evidence from a systematic review of quality improvement initiatives in diabetes. This information was reviewed at a multistakeholder workshop where potential quality improvement initiatives were considered at various service levels.
  
  
  RESULTS
  A pilot survey involving 59 patients with diabetes and a focus group of primary care and allied health care providers identified several important barriers to optimal outcomes in diabetes care, including patient-level financial barriers to care and difficulty navigating the health system. Our collaborative discussion using the knowledge-to-action cycle prioritized feasible, evidence-based interventions to improve outcomes for patients with diabetes, including enabling care by allied health care providers and creating clear care maps and processes for system navigation.
  
  
  CONCLUSIONS
  We identified important barriers to achieving optimal outcomes in diabetes that may be overcome through the use of evidence-based quality improvement interventions. As recommended within the knowledge-to-action cycle, future research is required to determine whether program implementation improves outcomes and is cost-effective.
authors: Department of Medicine, University of Calgary, Calgary, Alta. ; Libin Cardiovascular Institute and Institute for Population Health, University of Calgary, Calgary, Alta.
authors: Braden
authors: B
authors: Manns
authors: Interdisciplinary Chronic Disease Collaboration, University of Calgary, Calgary, Alta. ; Department of Family Medicine, Alberta Health Services, Calgary, Alta.
authors: Ted
authors: T
authors: Braun
authors: Department of Medicine, University of Calgary, Calgary, Alta. ; Obesity, Diabetes and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alta.
authors: Alun
authors: A
authors: Edwards
authors: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
authors: Jeremy
authors: J
authors: Grimshaw
authors: Department of Medicine, University of Calgary, Calgary, Alta. ; Libin Cardiovascular Institute and Institute for Population Health, University of Calgary, Calgary, Alta.
authors: Brenda
authors: B
authors: Hemmelgarn
authors: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
authors: Don
authors: D
authors: Husereau
authors: Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Ont. ; Department of Family and Community Medicine, University of Toronto, Toronto, Ont.
authors: Noah
authors: N
authors: Ivers
authors: Obesity, Diabetes and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alta. ; Department of Public Health Sciences, University of Alberta, Edmonton, Alta.
authors: Jeff
authors: J
authors: Johnson
authors: Alberta Health, Edmonton, Alta.
authors: Steve
authors: S
authors: Long
authors: Interdisciplinary Chronic Disease Collaboration, University of Calgary, Calgary, Alta. ; Department of Family Medicine, University of Calgary, Calgary, Alta.
authors: Kerry
authors: K
authors: McBrien
authors: Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alta. ; Calgary Laboratory Services, Calgary, Alta.
authors: Christopher
authors: C
authors: Naugler
authors: Department of Medicine, University of Calgary, Calgary, Alta.
authors: Peter
authors: P
authors: Sargious
authors: Department of Medicine, University of Toronto, Toronto, Ont. ; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.
authors: Sharon
authors: S
authors: Straus
authors: Interdisciplinary Chronic Disease Collaboration, University of Calgary, Calgary, Alta. ; Department of Medicine, University of Alberta, Edmonton, Alta.
authors: Marcello
authors: M
authors: Tonelli
authors: Department of Medicine, University of Toronto, Toronto, Ont. ; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.
authors: Andrea C
authors: AC
authors: Tricco
authors: Department of Medicine, University of Toronto, Toronto, Ont. ; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ont.
authors: Catherine
authors: C
authors: Yu