Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial

Russell, Anthony; Baxter, Kimberley; Askew, Deborah; Tsai, Josh; Ware, Robert S.; Jackson, Claire

doi:10.1111/dme.12251

Cited by 54 publications

(88 citation statements)

References 28 publications

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“…GPwSIs undertake advanced training in the condition prior to working in the clinic. The model was first tested in complex diabetes care with promising results, in clinical outcomes, service efficiency and patient satisfaction [22]. A formal randomised controlled trial (RCT) is underway [23].…”

Section: Discussionmentioning

confidence: 99%

Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study

et al. 2014

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BackgroundMost people die of non-malignant disease, but most patients of specialist palliative care services have cancer. Adequate end of life care for people with non-malignant disease requires acknowledgement of their limited prognosis and appropriate care planning. Case conferences between specialist palliative care services and GPs improve outcomes in cancer-based populations. We report a pilot study of case conferences between the patient’s GP and specialist staff to facilitate care planning for people with end stage heart failure or non-malignant lung disease in a regional health service in Queensland Australia.MethodsSingle face to face case conferences about patients with a primary diagnosis of advanced heart failure or respiratory failure from non-malignant disease were conducted between a palliative care consultant, a case management nurse and the patient’s GP. Annualised rates of service utilisation (emergency department [ED] presentations, ED discharges back to home, hospital admissions, and admission length of stay) before and after case conference were calculated. Content and counts of case conference recommendations, and the rate of adherence to recommendations were also assessed. A process evaluation of case conferences was undertaken.ResultsTwenty-three case conferences involving 21 GPs were conducted between November 2011 and November 2012. One GP refused to participate. Ten patients died, three at home. Of 82 management recommendations made, 55 (67%) were enacted. ED admissions fell from 13.9 per annum (pa) to 2.1 (difference 11.8, 95% CI 2.2-21.3, p = 0.001); ED admissions leading to discharge home from 3.9 to 0.4 pa (difference 3.5, 95% CI -0.4-7.5, p = 0.05); hospital admissions from 11.4 to 3.5 pa (difference 7.9, 95% CI 2.2-13.7, p = 0.002); and length of stay from 7.0 to 3.7 days (difference 3.4, 95% CI 0.9-5.8, p = 0.007). Participating health professionals were enthusiastic about the process.ConclusionsThis pilot is the initial step in the development and testing of a complex intervention based on a model of integrated care. A single case conference involving the patient’s heart or lung failure team is associated with significant reductions in service utilization, apparently by improving case coordination, enhancing symptom management and assessing and managing carer needs. A randomized controlled trial is being developed.Trial registrationAustralian and New Zealand Controlled Trials Register ACTRN12613001377729: Registered 16/12/2013.

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Section: Discussionmentioning

confidence: 99%

Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study

et al. 2014

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“…The program also required and supported a stream of empirical research, undertaken in parallel with the change effort, on the organizational challenges and patient and staff experience of the new model. Research activities included a development and pilot study of a primary care improvement tool, a qualitative evaluation of a clinical microsystems model in diabetes care, a quantitative study of the evidence‐practice gap in gestational diabetes follow‐up, and the development and evaluation of a community‐based diabetes surveillance and management program …”

Section: Case Study: Co‐creation In a Primary Care “Beacon” Practicementioning

confidence: 99%

Achieving Research Impact Through Co‐creation in Community‐Based Health Services: Literature Review and Case Study

Greenhalgh

Jackson

Shaw

et al. 2016

The Milbank Quarterly

796

836

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Policy Points: Co‐creation—collaborative knowledge generation by academics working alongside other stakeholders—is an increasingly popular approach to aligning research and service development.It has potential for “moving beyond the ivory towers” to deliver significant societal impact via dynamic, locally adaptive community‐academic partnerships.Principles of successful co‐creation include a systems perspective, a creative approach to research focused on improving human experience, and careful attention to governance and process.If these principles are not followed, co‐creation efforts may fail. ContextCo‐creation—collaborative knowledge generation by academics working alongside other stakeholders—reflects a “Mode 2” relationship (knowledge production rather than knowledge translation) between universities and society. Co‐creation is widely believed to increase research impact.MethodsWe undertook a narrative review of different models of co‐creation relevant to community‐based health services. We contrasted their diverse disciplinary roots and highlighted their common philosophical assumptions, principles of success, and explanations for failures. We applied these to an empirical case study of a community‐based research‐service partnership led by the Centre of Research Excellence in Quality and Safety in Integrated Primary‐Secondary Care at the University of Queensland, Australia.FindingsCo‐creation emerged independently in several fields, including business studies (“value co‐creation”), design science (“experience‐based co‐design”), computer science (“technology co‐design”), and community development (“participatory research”). These diverse models share some common features, which were also evident in the case study. Key success principles included (1) a systems perspective (assuming emergence, local adaptation, and nonlinearity); (2) the framing of research as a creative enterprise with human experience at its core; and (3) an emphasis on process (the framing of the program, the nature of relationships, and governance and facilitation arrangements, especially the style of leadership and how conflict is managed). In both the literature review and the case study, co‐creation “failures” could often be tracked back to abandoning (or never adopting) these principles. All co‐creation models made strong claims for significant and sustainable societal impacts as a result of the adaptive and developmental research process; these were illustrated in the case study.ConclusionsCo‐creation models have high potential for societal impact but depend critically on key success principles. To capture the nonlinear chains of causation in the co‐creation pathway, impact metrics must reflect the dynamic nature and complex interdependencies of health research systems and address processes as well as outcomes.

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“…The missing link is the systems physician who endeavours to develop solutions by means of large‐scale changes in work practices and system redesign. Examples of what systems physicians can achieve are described in Table …”

Section: Systems Physicians As a Possible Solutionmentioning

confidence: 99%

Arise the systems physician

Scott

Phelps

Dalton

2014

Internal Medicine Journal

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Healthcare in Australia faces significant challenges. Variations in care, suboptimal safety and reliability, fragmentation of care and unsustainable cost increases are compounded by substantial overuse and underuse of clinical interventions. These problems arise not from intentional actions of individual clinicians, but from deficiencies in the design, operations and governance of systems of care. Physicians play an important role in optimising systems of care and, in doing so, must rely on enhanced skills in a range of domains. These include: how to evaluate and improve quality and safety of clinical processes; analyse and interpret clinical and administrative data in ways that can be used to enhance care delivery; build and lead cohesive multidisciplinary teams capable of solving operational defects and inefficient workarounds; and implement new and effective innovations in clinical service delivery. While clinical skills are essential in individual patient care, skills that improve systems of care targeting whole patient populations will become increasingly desirable and recognised as core skills.

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Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial

Abstract: A community-based, integrated model of complex diabetes care, delivered by general practitioners with advanced skills, produced clinical and process benefits compared with a tertiary diabetes outpatient clinic.

Cited by 54 publications

References 28 publications

Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study

Case conferences between general practitioners and specialist teams to plan end of life care of people with end stage heart failure and lung disease: an exploratory pilot study

Achieving Research Impact Through Co‐creation in Community‐Based Health Services: Literature Review and Case Study

Arise the systems physician

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