6th UK and Ireland Implementation Science Research Conference 2023

How do teams tailor improvements in diabetes care: Preliminary findings from a Process Evaluation study

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PRESENter

Elaine O' Halloran
Elaine 1

authors

Elaine O’ Halloran, Melissa Girling, Michael Sykes and Tracy Finch (on behalf of the EQUIPD team)

Biography

Elaine works within the Dept. of Nursing, Midwifery and Health at Northumbria University as a Senior Research Assistant on the EQUIPD study. The study will evaluate quality improvement collaboratives aligned to a national audit of diabetes care, to improve the uptake of insulin pumps for people with diabetes in England and Wales.

Elaine qualified with a BA (Hons) in Applied Psychology from University College Cork (UCC) in 2005 and then completed an MA in Forensic Psychology at UCC and subsequently an MSc in Health Psychology from the University of Galway in 2021.

Prior to joining Northumbria University, Elaine worked in a variety of roles within the health and social care sector including in disability, autism and mental health services, as well as in teaching and training.

background

NICE guidelines recommend insulin pump therapy for the treatment of Type 1 Diabetes patients with HbA1c above 69mmol/mol. There are about 60,000 patients that meet these criteria but who do not use a pump and significant variation by deprivation, ethnicity, sex, and location. Much of this variation is likely to be attributable to staff and local organisational factors.
Diabetes services across England and Wales were invited to participate in a trial evaluating the effectiveness of a Quality Improvement Collaborative (QIC) aligned to the National Diabetes Audit to increase the use of insulin pumps. The QIC supports diabetes specialist teams to select, and generate commitment for, improvement actions aligned to their local influences and contexts. Within the QIC, the Theoretical Domains Framework is used by clinical teams to identify influences upon care. Teams then undertake a virtual logic model exercise to align improvement strategies to these influences. We aim to describe how teams enact tailoring.

MEthod

We use observations, documentary analysis and semi-structured interviews to explore how teams undertake tailoring work during the initial workshops and throughout the 15-month QIC. We categorise the selected and enacted improvement actions using the Expert Recommendations for Implementing Change (ERIC).

results

Preliminary findings from the QIC workshops describing the links between the diabetes care pathway, identified influences and proposed improvement strategies will be presented. Influences relate to patient (e.g., skills, emotion), staff (e.g., motivation, beliefs about capacity) and contextual factors (e.g., environmental context, social influences).

Conclusion

Exploring how teams identify the factors that influence their practice, and how and why these influences link to the strategies selected by teams to improve quality in their local contexts will support our understanding of the effectiveness of tailoring in complex interventions.