Bridging the gap: a qualitative process evaluation from the perspectives of healthcare professionals of an audit-and-feedback-based intervention to improve transition to adult care for young people living with type 1 diabetes.

Autor: Parsons JA; Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada. j.parsons@utoronto.ca.; Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. j.parsons@utoronto.ca., Wigle J; Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada., Zenlea I; Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.; Institute of Health Policy Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.; Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Ivers N; Institute of Health Policy Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.; Women's College Institute for Health System Solutions and Virtual Care, and Department of Family Medicine, Women's College Hospital, Toronto, Canada., Mukerji G; Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada., Landry A; Department of Pediatrics, Oak Valley Health, Markham, ON, Canada., Punthakee Z; Department of Medicine, McMaster University, Hamilton, ON, Canada., Clarson CL; Department of Paediatrics, University of Western Ontario, London, ON, Canada., Shulman R; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.; Division of Endocrinology, The Hospital for Sick Children, Sickkids Research Institute, Toronto, Canada.; Department of Paediatrics, University of Toronto, Toronto, Canada.; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 Oct 23; Vol. 24 (1), pp. 1276. Date of Electronic Publication: 2024 Oct 23.
DOI: 10.1186/s12913-024-11734-1
Abstrakt: Background: The transition from pediatric to adult care is a vulnerable time for young people living with type 1 diabetes (T1D). Bridging the Gap (BTG) is an audit-and-feedback (AF) intervention aimed at improving both transitions-in-care processes and diabetes management in the year following transition. As part of BTG, we conducted a qualitative process evaluation to understand: (a) what was implemented and how; and (b) the contextual factors (micro-, meso- and macro-) that affected implementation, outcomes and study processes.
Methods: Using qualitative descriptive methodology, interviews were conducted with 13 healthcare professionals (HCPs) delivering diabetes care to transitioning youth. Participants were asked about their experiences of BTG study processes and feedback tools, the quality improvement (QI) initiatives implemented at their site, and potential spread and scale. Interviews also explored the impacts of COVID-19 on transition care and study processes and results.
Results: Five key themes were identified. Participants' reflections on the BTG study design indicated they appreciated its flexible, site-specific approach to QI, which they saw as crucial to the success of their initiatives. Engagement with feedback reports and other study resources provided comparative, site-specific data. Participants described the challenges posed by the COVID-19 pandemic and its impacts on patients, care provision and study implementation. Their site-specific QI initiatives resulted in changes to their transition practices. Finally, participants commented on how BTG and its processes fostered a community of practice (CoP) between sites, resulting in new opportunities to collaborate and share experiences.
Conclusions: BTG resulted in a CoP among practitioners delivering transition care to youth with T1D, which could be scaled up to promote a learning health system in pediatric diabetes care. Qualitative process evaluation is a useful tool for understanding how contextual factors affect the implementation and outcomes of complex QI interventions.
(© 2024. The Author(s).)
Databáze: MEDLINE
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