Comparing the implementation of team approaches for improving diabetes care in community health centers
Open accessAbstract
BACKGROUND: Patient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. METHODS: Mixed methods study with interviews and surveys of clinicians and staff participating in a study comparing the effectiveness of MA and CHW health coaching for improving diabetes care. Participants included 24 key informants in five role categories and 249 clinicians and staff survey respondents from 14 participating practices. We conducted thematic analyses of key informant interview transcripts to clarify implementation processes and describe barriers to integrating the new roles into practice. We surveyed clinicians and staff to assess differences in practice culture among intervention and control groups. We triangulated findings to identify concordant and disparate results across data sources. RESULTS: Implementation processes and experiences varied considerably among the practices implementing CHW and MA team-based approaches, resulting in differences in the organization of health coaching and self-management support activities. Importantly, CHW and MA responsibilities converged over time to focus on health coaching of diabetic patients. MA health coaches experienced difficulty in allocating dedicated time due to other MA responsibilities that often crowded out time for diabetic patient health coaching. Time constraints also limited the personal introduction of patients to health coaches by clinicians. Participants highlighted the importance of a supportive team climate and proactive leadership as important enablers for MAs and CHWs to implement their health coaching responsibilities and also promoted professional growth. CONCLUSION: Implementation of team-based strategies to improve diabetes care for vulnerable populations was diverse, however all practices converged in their foci on health coaching roles of CHWs and MAs. Our study suggests that a flexible approach to implementing health coaching is more important than fidelity to rigid models that do not allow for variable allocation of responsibilities across team members. Clinicians play an instrumental role in supporting health coaches to grow into their new patient care responsibilities.
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In primary care, there were mixed perceptions of stable vs. rotating staff when adding a new team role (i.e., health coach).
“Lastly, another study in primary care found mixed perceptions of stable vs. rotating staff when adding a new team role (i.e., health coach); some team members liked rotating through different roles while others wanted more stability [94].”
From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [94]
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- Authors
- Van der Wees, P. J., Friedberg, M. W., Guzman, E. A., Ayanian, J. Z., & Rodriguez, H. P.
- Affiliations
- Brigham and Women's Hospital (US)
- Community Health Partnership (US)
- Venue
- BMC Health Services Research
- Published
- 2014-12
- Volume
- 14
- Issue
- 1
- Pages
- 608-608
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC4264557
- OpenAlex
- W2139777789
- Cited by
- 29
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 5 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 1
- FWCI
- 4.81
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- eScholarship (California Digital Library) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Commonwealth Fund
- Agency for Healthcare Research and Quality (R18HS020120)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Keywords
- diabetes management, community health centers, community health workers, medical assistants, health coaching, self-management support, team-based care, implementation barriers, practice culture, vulnerable populations
- MeSH terms
- Community Health Workers, Community Health Centers, Diabetes Mellitus, Female, Humans, Interviews as Topic, Leadership, Male, Organizational Innovation, Patient Care Team, Self Care, Los Angeles, Qualitative Research, Quality Improvement
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