Study protocol

Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care

Martin P Eccles¹ , Gillian Hawthorne² , Marie Johnston³ , Margaret Hunter¹ , Nick Steen¹ , Jill Francis⁴ , Susan Hrisos¹ , Marko Elovainio⁵ and Jeremy M Grimshaw^6,7

¹  Institute of Health and Society, University of Newcastle upon Tyne, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK

²  Newcastle Diabetes Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne, NE4 6BE, UK

³  College of Life Sciences and Medicine, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK

⁴  Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK

⁵  National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland

⁶  Ottawa Health Research Institute, 1053 Carling Avenue, Room 2-017, Admin Building, Ottawa, ON K1Y 4E9, Canada

⁷  Department of Medicine, University of Ottawa, Ontario, Canada, K1H 8M5

author email corresponding author email

Implementation Science 2009, 4:22doi:10.1186/1748-5908-4-22

Published:	27 April 2009

Abstract

Background

Type 2 diabetes is an increasingly prevalent chronic illness and is an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of the primary care team. Studies of the quality of care for patients with diabetes suggest less than optimum care in a number of areas.

Aim

The aim of this study is to improve the quality of care for patients with diabetes cared for in primary care in the UK by identifying individual, team, and organisational factors that predict the implementation of best practice.

Design

Participants will be clinical and non-clinical staff within 100 general practices sampled from practices who are members of the MRC General Practice Research Framework. Self-completion questionnaires will be developed to measure the attributes of individual health care professionals, primary care teams (including both clinical and non-clinical staff), and their organisation in primary care. Questionnaires will be administered using postal survey methods. A range of validated theories will be used as a framework for the questionnaire instruments. Data relating to a range of dimensions of the organisational structure of primary care will be collected via a telephone interview at each practice using a structured interview schedule. We will also collect data relating to the processes of care, markers of biochemical control, and relevant indicator scores from the quality and outcomes framework (QOF). Process data (as a proxy indicator of clinical behaviours) will be collected from practice databases and via a postal questionnaire survey of a random selection of patients from each practice. Levels of biochemical control will be extracted from practice databases. A series of analyses will be conducted to relate the individual, team, and organisational data to the process, control, and QOF data to identify configurations associated with high quality care.

Study registration

UKCRN ref:DRN120 (ICPD)