title: Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE).
abstract: OBJECTIVE
  Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real-world evaluation.
  
  
  METHODS
  Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real-world comprehensive evaluations in health care settings.
  
  
  RESULTS
  The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub-steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built-in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation.
  
  
  CONCLUSIONS
  This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale-up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases.
authors.affiliation: Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Jann.Paquette-Warren@schulich.uwo.ca.
authors.forename: Jann
authors.initials: J
authors.lastname: Paquette-Warren
authors.affiliation: Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Harris
authors.affiliation: Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Mariam
authors.initials: M
authors.lastname: Naqshbandi Hayward
authors.affiliation: Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Tompkins
mesh_terms: D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000628:therapy*; D019317:Evidence-Based Medicine; D006291:Health Policy; D019982:Organizational Case Studies; D010346:Patient Care Management / Q000592:standards*; D015397:Program Evaluation / Q000379:methods*; D058996:Quality Improvement
keywords: case study; diabetes mellitus; evaluation; framework; health policy; quality improvement