Improving outpatient diabetes care.

Area of Science:

• Health Services Research
• Diabetes Management
• Healthcare Quality Improvement

Background:

• Diabetes affects over 20% of patients within the Veterans Health Administration (VHA).
• Disseminating best practices in outpatient diabetes care is crucial for improving patient outcomes.
• Identifying factors associated with high-performing diabetes care is essential for quality improvement initiatives.

Purpose of the Study:

• To identify best practices in outpatient diabetes care within the VHA.
• To determine factors associated with the development and implementation of these best practices.
• To inform the dissemination of successful strategies across the VHA.

Main Methods:

• Utilized a national VHA diabetes registry (2008 data) to stratify facilities into high, mid, and low performers based on A1c control.
• Conducted semistructured telephone interviews with staff at various performance levels.
• Performed site visits to gain deeper insights into clinical operations and team dynamics.

Main Results:

• Low-performing sites identified lack of physician-nurse teamwork and insufficient preparation time as barriers.
• High-performing sites reported supportive clinical teams, efficient work-sharing, and dedicated time for non-face-to-face patient care.
• Innovative practices tailored to local needs were observed at better-performing facilities.

Conclusions:

• Significant differences in clinical performance and practice patterns exist among VHA outpatient facilities.
• Supportive clinical teams, efficient workflows, and allocated time for care are key factors in high-quality diabetes management.
• Best practices identified will be disseminated as part of the VHA Patient-Centered Medical Home model implementation.