A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

<p>Abstract</p> <p>Background</p> <p>Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids – three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is practice facilitation (PF). PF creates time for learning and reflection by members of the team in each clinic, improves their communication, and promotes an individualized approach to implement a strategy to improve patient outcomes.</p> <p>Specific objectives</p> <p>The specific objectives of this protocol are to: evaluate the effectiveness and sustainability of PF to improve risk factor control in patients with type 2 diabetes across a variety of primary care settings; assess the implementation of the CCM in response to the intervention; examine the relationship between communication within the practice team and the implementation of the CCM; and determine the cost of the intervention both from the perspective of the organization conducting the PF intervention and from the perspective of the primary care practice.</p> <p>Intervention</p> <p>The study will be a group randomized trial conducted in 40 primary care clinics. Data will be collected on all clinics, with 60 patients in each clinic, using a multi-method assessment process at baseline, 12, and 24 months. The intervention, PF, will consist of a series of practice improvement team meetings led by trained facilitators over 12 months. Primary hypotheses will be tested with 12-month outcome data. Sustainability of the intervention will be tested using 24 month data. Insights gained will be included in a delayed intervention conducted in control practices and evaluated in a pre-post design.</p> <p>Primary and secondary outcomes</p> <p>To test hypotheses, the unit of randomization will be the clinic. The unit of analysis will be the repeated measure of each risk factor for each patient, nested within the clinic. The repeated measure of glycosylated hemoglobin A1c will be the primary outcome, with BP and Low Density Lipoprotein (LDL) cholesterol as secondary outcomes. To study change in risk factor level, a hierarchical or random effect model will be used to account for the nesting of repeated measurement of risk factor within patients and patients within clinics.</p> <p>This protocol follows the CONSORT guidelines and is registered per ICMJE guidelines:</p> <p>Clinical Trial Registration Number</p> <p>NCT00482768</p

Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes

<p>Abstract</p> <p>Background</p> <p>Despite the development of several models of care delivery for patients with chronic illness, consistent improvements in outcomes have not been achieved. These inconsistent results may be less related to the content of the models themselves, but to their underlying conceptualization of clinical settings as linear, predictable systems. The science of complex adaptive systems (CAS), suggests that clinical settings are non-linear, and increasingly has been used as a framework for describing and understanding clinical systems. The purpose of this study is to broaden the conceptualization by examining the relationship between interventions that leverage CAS characteristics in intervention design and implementation, and effectiveness of reported outcomes for patients with Type II diabetes.</p> <p>Methods</p> <p>We conducted a systematic review of the literature on organizational interventions to improve care of Type II diabetes. For each study we recorded measured process and clinical outcomes of diabetic patients. Two independent reviewers gave each study a score that reflected whether organizational interventions reflected one or more characteristics of a complex adaptive system. The effectiveness of the intervention was assessed by standardizing the scoring of the results of each study as 0 (no effect), 0.5 (mixed effect), or 1.0 (effective).</p> <p>Results</p> <p>Out of 157 potentially eligible studies, 32 met our eligibility criteria. Most studies were felt to utilize at least one CAS characteristic in their intervention designs, and ninety-one percent were scored as either "mixed effect" or "effective." The number of CAS characteristics present in each intervention was associated with effectiveness (p = 0.002). Two individual CAS characteristics were associated with effectiveness: interconnections between participants and co-evolution.</p> <p>Conclusion</p> <p>The significant association between CAS characteristics and effectiveness of reported outcomes for patients with Type II diabetes suggests that complexity science may provide an effective framework for designing and implementing interventions that lead to improved patient outcomes.</p

A Systemic and holistic approach to optimize university student success by means of the out-of-class experience

Please help populate SUNScholar with the full text of SU research output. Also - should you need this item urgently, please snd us the details and we will try to get hold of the full text as quick possible. E-mail to [email protected]. Thank you.AlgemeenSentrum vir Studentevoorligting en ?ontwikkeling (SSVO

Intergrating university research, teaching and community service: a practice of greater social relevance.

AlgemeenSentrum vir Studentevoorligting en �ontwikkeling (SSVO)Please help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

"Adolescent" South Africa (18 Years Since Democratization): Challenges for Universities to Optimize Wellness as a Prerequisite for Cognitive Development and Learning in a Diverse Society

AlgemeenAfdeling Studente- en Akademiese Steun (SAS)Please help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Thinking styles: implications for optimising learning and teaching in university education.

OpvoedkundeOpvoedkundige Sielkunde En Spesiale OnderwysPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Theory-based prediction of academic performance at a South African university

OpvoedkundeOpvoedkundige Sielkunde En Spesiale OnderwysPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

The impact and cost-effectiveness of student counselling in the context of higher education: A literature review

The need for and relevance of student counselling has been well argued for in past research, and has been duly recognised at governmental level in South Africa. However, this recognition necessarily calls for accountability from student counselling centres. In this regard, it becomes increasingly important to evaluate student counselling services in terms of their cost-effectiveness and the impact their services have. In this article, different methods for determining cost-effectiveness are outlined and the most applicable method in different cases indicated. Subsequently, research on cost-effectiveness and the impact of student counselling services are reviewed. Research findings on the impact and cost-effectiveness of policies, organisational structure, collaboration between different institutional service centres and counsellor characteristics are reviewed. In particular, it was found that collaboration between student-directed services within the broader University context contribute to cost-effectiveness and impact. It is concluded that more empirical research is needed to justify the claims of relevance of student counselling services. Suggestions are made as to how impact and cost-effectiveness can be studied at institutional level. Furthermore, it is suggested that research findings on counsellor characteristics should be integrated in the impact and costeffectiveness studies of student counselling services. South African Journal of Higher Education Vol. 20 (2) 2006: 261-27

Mind the education in the out-of-class context: Integrated learning communities to educate the minds of unversity students

Please help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected] Studente- en Akademiese Steun (SAS