Physician practices identify strategies for managing change

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Strategies for improving diabetes care could lead to better treatments for other chronic conditions as well.

Successfully managing change was part of a new study of primary care practices that ranked highly in diabetes care improvement in Minnesota, where scores were calculated based on mandatory reporting of performance data.

“Improving diabetes outcomes in primary care depends on successfully implementing effective changes to diabetes care,” said a news release about the findings. “However, changes can be disruptive in a busy practice, and problems with clinician engagement, staff education, or support from leadership can render changes ineffective and compromise results.”

Studying high performers

It’s clear physicians need to improve diabetes outcomes in primary care, and it’s a common focus of quality improvement strategies. What’s less clear is exactly how to do so while managing a busy practice, the study said.

There were 330 practices that completed the Physician Practice Connections Readiness Survey in 2017 and 2019, with at least 30 patients aged 18 to 75 years with diabetes per year. Optimal care was defined as patients having concurrent control of blood glucose and blood pressure, using a statin and an antiplatelet drug, and not smoking.

Among the top 13 practices, 10 agreed to interviews, with nine conducted on-site. Researchers overseen by the University of Minnesota Institutional Review Board asked three questions to prompt discussion about how practice leaders manage changes:

• What changes do you think contributed most to that improvement in Optimal Diabetes Care scores?
• How did you implement those changes? Did you use any particular strategies?
• Were there any other factors that contributed to your improvement?

Among 10 of the top practices, health leaders described 13 distinct care management strategies. The nine most common were:

• Standardizing the care process
• Performance awareness
• Enhancing care teams
• Health care organization participation
• Improving reporting systems
• Engaging staff and clinicians
• Accountability for tasks
• Engaging leadership
• Tracking change

The top practices did not work together. The only strategy identified by all was standardization of diabetes care management processes, which clarified roles and simplified interactions among staff, the study said.

“All practices defined a uniform process to address the challenges of managing complex disease in a busy clinical setting,” the study said.

The researchers noted the “change management strategies are not goals to accomplish and do not lend themselves to establishment of simple metrics; however, together they provide a perspective for how successful practices manage change during performance improvement.”

Other practices might benefit by using them to identify strengths and weaknesses in their own methods for managing change while integrating practice improvements, the study said.

Care management themes identified by most practices included proactive care, improving patient relationships, and previsit planning. “Establishing a strong relationship was acknowledged as important for enhancing patient adherence to recommendations and promoting behavioral change,” the study said.

“Successful Change Management Strategies for Improving Diabetes Care Delivery Among High-Performing Practices” was published in The Annals of Family Medicine.