title: Fidelity of implementation to a care team redesign and improved outcomes of diabetes care.
abstract: OBJECTIVE
  We assessed fidelity of implementation (FOI) to the intended features of a primary care team redesign that integrated registered nurse care managers and patient health coaches onto existing care teams. The relation of FOI ranking and improvements in intermediate outcomes of diabetes care was examined.
  
  
  METHODS
  We assessed FOI by interviewing frontline primary care team members (n = 20). We explored the relation of FOI and outcomes of diabetes care (n = 10 206 patients) over a 3-year period (2010-12). Multilevel, multivariate regression estimated the relation of FOI and improvements in outcomes of diabetes care.
  
  
  METHODS
  Five primary care practices in greater Los Angeles, CA, USA.
  
  
  METHODS
  Ten thousand, two hundred and six adult patients with diabetes; 20 frontline primary care clinicians and staff.
  
  
  METHODS
  Blood pressure, hemoglobin A1c (HbA1c) and low-density lipoprotein cholesterol (LDL-C) control among adult diabetic patients.
  
  
  RESULTS
  All practices improved diabetic patients' LDL-C control over time. In adjusted analyses, the practice with the highest FOI achieved the largest improvement in blood pressure and HbA1c control among diabetic patients. In contrast, the practice with the lowest FOI had the least improvements in blood pressure, HbA1c and LDL-C control. FOI was an inconsistent predictor of intermediate outcomes of diabetes care for other practices.
  
  
  CONCLUSIONS
  FOI assessment can be useful for identifying low FOI to a redesign so that technical assistance and resources can be provided to improve team functioning and patient outcomes. High FOI can enable greater improvements in patient outcomes in the context of primary care practice redesign.
authors.affiliation: Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles E Young Drive South, Los Angeles, CA 90095, USA.
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Grace
authors.affiliation: HealthCare Partners Institute for Applied Research and Education, 19191 South Vermont Avenue, Suite 200, Torrance, CA 90502, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Rich
authors.affiliation: HealthCare Partners Medial Group and Affiliated Physicians, 19191 South Vermont Avenue, Suite 200, Torrance, CA 90502, USA.
authors.forename: William
authors.initials: W
authors.lastname: Chin
authors.affiliation: Division of Health Policy and Management, University of California, Berkeley School of Public Health, 50 University Hall, Room 245, Berkeley, CA 94720, USA.
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D003142:Communication; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D007857:Leadership; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
keywords: diabetes care; fidelity of implementation; patient outcomes; practice redesign; primary care teams