PT  - JOURNAL ARTICLE
AU  - Solberg, Leif I.
AU  - Peterson, Kevin A.
AU  - Fu, Helen
AU  - Eder, Milton
AU  - Jacobsen, Rachel
AU  - Carlin, Caroline S.
TI  - Strategies and Factors Associated With Top Performance in Primary Care for Diabetes: Insights From a Mixed Methods Study
AID  - 10.1370/afm.2646
DP  - 2021 Mar 01
TA  - The Annals of Family Medicine
PG  - 110--116
VI  - 19
IP  - 2
4099  - http://www.annfammed.org/content/19/2/110.short
4100  - http://www.annfammed.org/content/19/2/110.full
SO  - Ann Fam Med2021 Mar 01; 19
AB  - PURPOSE The aim of this study was to determine what strategies and factors are most important for high performance in the primary care of patients with diabetes.METHODS We performed a mixed-methods, cross-sectional, observational analysis of interviews and characteristics of primary care clinics in Minnesota and bordering areas. We compared strategies, facilitators, and barriers identified by 31 leaders of 17 clinics in high-, middle-, and low-performance quartiles on a standardized composite measure of diabetes outcomes for 416 of 586 primary care clinics. Semistructured interview data were combined with quantitative data regarding clinic performance and a survey of the presence of care management processes.RESULTS The interview analysis identified 10 themes providing unique insights into the factors and strategies characterizing the 3 performance groups. The main difference was the degree to which top-performing clinics used patient data to guide proactive and outreach methods to intensify treatment and monitor effect. Top clinics also appeared to view visit-based care management processes as necessary but insufficient, whereas all respondents regarded being part of a large system as mostly helpful.CONCLUSIONS Top-performing clinic approaches to diabetes care differ from lower-performing clinics primarily by emphasizing data-driven proactive outreach to patients to intensify treatment. Although confirmatory studies are needed, clinical leaders should consider the value of this paradigm shift in approach to care.