Strategies and factors associated with top performance in primary care for diabetes: Insights from a mixed methods study

Leif I. Solberg, Kevin A. Peterson, Helen Fu, Milton Eder, Rachel Jacobsen, Caroline S. Carlin

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


PURPOSE The aim of this study was to determine what strategies and factors are most important for high performance in the primary care of patients with diabetes. METHODS We performed a mixed-methods, cross-sectional, observational analysis of interviews and characteristics of primary care clinics in Minnesota and bordering areas. We compared strategies, facilitators, and barriers identified by 31 leaders of 17 clinics in high-, middle-, and low-performance quartiles on a standardized composite measure of diabetes outcomes for 416 of 586 primary care clinics. Semistructured interview data were combined with quantitative data regarding clinic performance and a survey of the presence of care management processes. RESULTS The interview analysis identified 10 themes providing unique insights into the factors and strategies characterizing the 3 performance groups. The main difference was the degree to which top-performing clinics used patient data to guide proactive and outreach methods to intensify treatment and monitor effect. Top clinics also appeared to view visit-based care management processes as necessary but insufficient, whereas all respondents regarded being part of a large system as mostly helpful. CONCLUSIONS Top-performing clinic approaches to diabetes care differ from lower-performing clinics primarily by emphasizing data-driven proactive outreach to patients to intensify treatment. Although confirmatory studies are needed, clinical leaders should consider the value of this paradigm shift in approach to care.

Original languageEnglish (US)
Pages (from-to)110-116
Number of pages7
JournalAnnals of family medicine
Issue number2
StatePublished - Mar 10 2021

Bibliographical note

Funding Information:
Key words: quality of health care; diabetes mellitus; delivery of health care; primary health care; organizational culture Funding support: This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (#R18DK110732). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2021, Annals of Family Medicine, Inc. All rights reserved.


  • Delivery of health care
  • Diabetes mellitus
  • Organizational culture
  • Primary health care
  • Quality of health care


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