TY - JOUR
T1 - Clinically relevant improvements achieved from a facilitated implementation of a gestational diabetes model of care
AU - Wilkinson, Shelley A.
AU - McCray, Sally J.
AU - Kempe, Alison
AU - Sellwood, Bernadette
N1 - Funding Information:
Funding was received from Allied Health Professions of Queensland to fund site visits for the present study. SW is supported by a Queensland Government Health Research Fellowship. ?Queensland Health - Health Research Fellowship (2015?2017) and AHPOQ (Allied Health Professions' Office Queensland) Collaboratives funding. Maternity leave RA support from Queensland Government ? Advance Queensland grant.
Funding Information:
Site 2’s additional barriers included lack of capacity for data entry, lack of clinical space, and difficulty adjusting administration processes (clinic appointment bookings), as well as barriers that resulted from the project team’s expectations of outcomes of and involvement in the project. Prior to project participation, Site 2 identified insufficient dietetic FTE to deliver the MOC in the implementation and had planned to use baseline data for a business case to obtain additional funding before engaging a wider group of stakeholders. Following the stakeholders being informed of the project and support from the District Allied Health manager, midwifery and endocrinology, funding was made available for additional data entry assistance for one week. When the project stalled prior to the implementation Phase due to difficulties obtaining funding for additional dietetic resources to deliver the MOC, higher level support was provided by the District Allied Health manager and Chief Allied Health Officer who had supported the project from the outset. This enabled a temporary increase of 0.5 FTE dietetics hours (20 hours/week) for the delivery of the implementation phase. These barriers resulted in a shorter baseline and implementation phases at Site 2.
Funding Information:
Funding was received from Allied Health Professions of Queensland to fund site visits for the present study. SW is supported by a Queensland Government Health Research Fellowship. †Queensland Health - Health Research Fellowship (2015–2017) and AHPOQ (Allied Health Professions’ Office Queensland) Collaboratives funding. Maternity leave RA support from Queensland Government – Advance Queensland grant.
Publisher Copyright:
© 2018 Dietitians Association of Australia
PY - 2018/7
Y1 - 2018/7
N2 - Aim: Medical nutrition therapy is a cornerstone treatment in gestational diabetes; however, most Australian women diagnosed with gestational diabetes do not receive this. The project evaluated adaptation of a successful evidence-based gestational diabetes model of care implementation from a tertiary centre into regional sites with varied demographics, population size and service capacity. Methods: The project used a hub (project team)-spoke (sites) model in Far North Queensland (Site 1) and regional South-East Queensland (Site 2). Sites selected demonstrated strong gestational diabetes team cohesiveness and project commitment. The project phases were consultation, baseline, transition and implementation. A best practice decision tree tool was provided to assess/manage barriers to the model of care and clinical outcomes captured through a project database. Results: Role clarification of site members, management engagement, site visits, decision tree and database refinement were completed in the project's first phase. Unexpected organisational and team barriers prevented timeline implementation as planned. Sites negotiated relevant reallocation of resources to achieve project deliverables. The proportion of women seen according to best practice increased from 3.5 to 87.8% (P < 0.001) (Site 1) and nil to 4.8% (P = 0.09) (Site 2), and those on medication dropped by 3.4 (Site 1) and 9.1% (Site 2). Conclusions: This project demonstrates a successful implementation using a facilitated and rigorous approach. Support, engagement and tools at many levels were keys to success at both sites. The present study illustrates the opportunities and challenges of conducting implementation research within routine clinical care, particularly in resource-challenged sites.
AB - Aim: Medical nutrition therapy is a cornerstone treatment in gestational diabetes; however, most Australian women diagnosed with gestational diabetes do not receive this. The project evaluated adaptation of a successful evidence-based gestational diabetes model of care implementation from a tertiary centre into regional sites with varied demographics, population size and service capacity. Methods: The project used a hub (project team)-spoke (sites) model in Far North Queensland (Site 1) and regional South-East Queensland (Site 2). Sites selected demonstrated strong gestational diabetes team cohesiveness and project commitment. The project phases were consultation, baseline, transition and implementation. A best practice decision tree tool was provided to assess/manage barriers to the model of care and clinical outcomes captured through a project database. Results: Role clarification of site members, management engagement, site visits, decision tree and database refinement were completed in the project's first phase. Unexpected organisational and team barriers prevented timeline implementation as planned. Sites negotiated relevant reallocation of resources to achieve project deliverables. The proportion of women seen according to best practice increased from 3.5 to 87.8% (P < 0.001) (Site 1) and nil to 4.8% (P = 0.09) (Site 2), and those on medication dropped by 3.4 (Site 1) and 9.1% (Site 2). Conclusions: This project demonstrates a successful implementation using a facilitated and rigorous approach. Support, engagement and tools at many levels were keys to success at both sites. The present study illustrates the opportunities and challenges of conducting implementation research within routine clinical care, particularly in resource-challenged sites.
UR - http://www.scopus.com/inward/record.url?scp=85041178588&partnerID=8YFLogxK
U2 - 10.1111/1747-0080.12404
DO - 10.1111/1747-0080.12404
M3 - Article
C2 - 29392816
AN - SCOPUS:85041178588
SN - 1446-6368
VL - 75
SP - 271
EP - 282
JO - Nutrition and Dietetics
JF - Nutrition and Dietetics
IS - 3
ER -