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

Janet A Parsons^{1

2}, Jannah Wigle³, Ian Zenlea^{4

5

6}, Noah Ivers^{5

7}, Geetha Mukerji^{8

9

10}, Alanna Landry¹¹, Zubin Punthakee¹², Cheril L Clarson¹³, Rayzel Shulman^{9

10

14

15

16}

Affiliations

¹ 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.
² Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. j.parsons@utoronto.ca.
³ Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
⁴ Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
⁵ Institute of Health Policy Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁶ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Women's College Institute for Health System Solutions and Virtual Care, and Department of Family Medicine, Women's College Hospital, Toronto, Canada.
⁸ Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Pediatrics, Oak Valley Health, Markham, ON, Canada.
¹² Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹³ Department of Paediatrics, University of Western Ontario, London, ON, Canada.
¹⁴ Division of Endocrinology, The Hospital for Sick Children, Sickkids Research Institute, Toronto, Canada.
¹⁵ Department of Paediatrics, University of Toronto, Toronto, Canada.
¹⁶ Institute of Medical Science, University of Toronto, Toronto, ON, Canada.

PMID: 39444012
PMCID: PMC11515547
DOI: 10.1186/s12913-024-11734-1

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

Janet A Parsons et al. BMC Health Serv Res. 2024.

. 2024 Oct 23;24(1):1276.

doi: 10.1186/s12913-024-11734-1.

Authors

Affiliations

¹ 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.
² Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. j.parsons@utoronto.ca.
³ Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
⁴ Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
⁵ Institute of Health Policy Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁶ Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Women's College Institute for Health System Solutions and Virtual Care, and Department of Family Medicine, Women's College Hospital, Toronto, Canada.
⁸ Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Pediatrics, Oak Valley Health, Markham, ON, Canada.
¹² Department of Medicine, McMaster University, Hamilton, ON, Canada.
¹³ Department of Paediatrics, University of Western Ontario, London, ON, Canada.
¹⁴ Division of Endocrinology, The Hospital for Sick Children, Sickkids Research Institute, Toronto, Canada.
¹⁵ Department of Paediatrics, University of Toronto, Toronto, Canada.
¹⁶ Institute of Medical Science, University of Toronto, Toronto, ON, Canada.

PMID: 39444012
PMCID: PMC11515547
DOI: 10.1186/s12913-024-11734-1

Abstract

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.

Keywords: Adolescence; Process evaluation; Qualitative methods; Quality improvement; Transitions in care; Type 1 diabetes mellitus.

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Conflict of interest statement

RS has received speaking and advisory board fees from Dexcom Canada. IZ reports receiving personal fees from Abbott Diabetes Care, Dexcom, Novo Nordisk Canada Inc., and the Ontario Association of Social Workers, and research funding support from the University of Toronto, Navigator Limited, Medical Psychiatry Alliance, Regional Municipality of Peel, Community Foundation of Mississauga, Canadian Institutes of Health Research. No other potential conflicts of interest relevant to this article were reported by the other authors.

References

1. Markowitz B, Parsons JA, Advani A. Diabetes in emerging Adulthood: transitions lost in translation. Can J Diabetes. Feb. 2017;41(1):1–5. 10.1016/j.jcjd.2016.06.004. - PubMed
1. Markowitz B, Pritlove C, Mukerji G, Lavery JV, Parsons JA, Advani A. The 3i conceptual Framework for recognizing patient perspectives of type 1 diabetes during emerging Adulthood. JAMA Netw Open. 2019. 10.1001/jamanetworkopen.2019.6944. - PMC - PubMed
1. Foster NC et al. Feb., State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018, Diabetes Technol Ther. 2019;21(2):66–72. 10.1089/dia.2018.0384. - PMC - PubMed
1. Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Sustained Effect of Intensive Treatment of Type 1 Diabetes Mellitus on Development and Progression of Diabetic Nephropathy: The Epidemiology of Diabetes Interventions and Complications (EDIC) Study, JAMA. 2003;290(16):2159–2167. 10.1001/jama.290.16.2159. - PMC - PubMed
1. Nathan DM, et al. Intensive Diabetes Treatment and Cardiovascular Disease in patients with type 1 diabetes. Patricia N Engl J Med. 2005;25(22):2643–53. [Online]. Available: www.nejm.org. - PMC - PubMed

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous