چکیده (انگلیسی):

Background:In 2008, the Sunshine Coast Division of General Practice (SCDGP) in Queensland, Australia initiated a
highly successful Improved Diabetes Management (IDM) program with general practices in a regional area. The IDM
program was evaluated against the 10 elements of a high functioning clinical microsystem framework as identified
by Nelson et al. (2007) in order to determine key factors contributing to the successful adoption and uptake of the
program in participating general practices.
Methods:The evaluation focussed on in-depth key informant interviews with 10 SCDGP staff and general
practitioners (GPs) involved in the IDM program. A thematic analysis was undertaken and common emergent
themes were reviewed against the 10 elements of high performing clinical microsystem.
Results:While all aspects of the clinical microsystem approach appeared effective in the design, implementation
and adoption of the IDM program, several characteristics were crucial. The identification of champions of change in
both the division and participating practices, the celebration of positive achievements and the use‘real data’ from
practices to demonstrate improved health outcomes for patients from the practice were instrumental in motivating
participating GPs to both implement and sustain changes in their diabetes care delivery.
Conclusion:In designing and redesigning health care, the clinical microsystems approach offers a pathway for the
effective uptake of innovation in Australian primary health care; a means of integrating structure, process and
outcomes of a care framework for reviewing improvements in the health care delivery process and could lead to
improvements in patient health outcomes.