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A positive deviance approach to understanding key features to improving diabetes care in the medical home

Resource type
Authors/contributors
Title
A positive deviance approach to understanding key features to improving diabetes care in the medical home
Abstract
PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/ lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and fi nancial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices' baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices' structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care.
Publication
Annals of Family Medicine
Volume
11
Issue
1
Pages
99-107
Date
2013
Language
English
DOI
10.1370/afm.1473
ISSN
1544-1709
Archive
Scopus
Library Catalog
Scopus
Citation
Gabbay, R. A., Friedberg, M. W., Miller-Day, M., Cronholm, P. F., Adelman, A., & Schneider, E. C. (2013). A positive deviance approach to understanding key features to improving diabetes care in the medical home. Annals of Family Medicine, 11(1), 99–107. Scopus. https://doi.org/10.1370/afm.1473