Article Text

Download PDFPDF
Quality improvement in community health centres: the role of microsystem characteristics in the implementation of a diabetes prevention initiative
  1. Calie Santana1,
  2. Marcella Nunez-Smith2,
  3. Anne Camp3,
  4. Erin Ruppe4,
  5. David Berg2,
  6. Leslie Curry2
  1. 1Division of General Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
  2. 2Yale School of Medicine, New Haven, Connecticut, USA
  3. 3Fair Haven Community Health Center, New Haven, Connecticut, USA
  4. 4Yale New Haven Hospital, New Haven, Connecticut, USA
  1. Correspondence to Dr Calie Santana, Division of General Internal Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10463, USA; casantan{at}


Objectives To examine the role of microsystem characteristics in the translation of an evidence-based intervention (the Diabetes Prevention Initiative (DPI)) into practice in a community-health centre (CHC).

Design Case study.

Analysis Constant comparative method of qualitative analysis.

Setting Community-health centre in a mid-sized city in the USA.

Participants 27 administrators, clinicians and staff of a community-health centre implementing a DPI.

Main outcome measures Perceptions of microsystem characteristics that influence the implementation of this initiative.

Results Five characteristics of high-performing microsystems were reflected, but not maximised, in the implementation of the DPI. First, there was no universally shared definition of the desired purpose of the DPI. Second, investment in quality improvement (QI) was strong, yet sustainability remained a concern, since efforts were dependent upon external grant support. Third, lack of cohesiveness between the initiative planning team and the rest of the organisation served to both facilitate and constrain implementation. Fourth, administrators showed both support for new initiatives and a lack of strategic vision for QI. Fifth, this initiative substantially strained already-stretched role definitions.

Conclusions Translation of the DPI in this CHC was constrained by the lack of a cohesive QI infrastructure and incomplete alignment with characteristics of high-performing microsystems. The findings suggest an important role for microsystem characteristics in the process of implementing evidence-based interventions. Enhancing the level of microsystem performance of CHCs is essential to informing efforts to improve quality of care in this critical safety-net system.

  • Quality improvement
  • community health centres
  • evidence-based practice
  • qualitative research
  • diabetes mellitus prevention and control
  • diabetes mellitus
  • evidence-based medicine
  • healthcare quality improvement
  • primary care

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding Robert Wood Johnson Foundation, Clinical Scholars Program.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the home institution of the academic researchers and by the research board of the community-health centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles