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When do trials of diabetes quality improvement strategies lead to sustained change in patient care?
  1. Emily L Kearsley-Ho1,
  2. Hsin Yun Yang1,
  3. Sathya Karunananthan2,
  4. Celia Laur3,
  5. Jeremy M Grimshaw1,2,
  6. Noah M Ivers3,4
  1. 1 Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  3. 3 Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
  4. 4 Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr. Noah M Ivers, Women’s College Research Institute and Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada; noah.ivers{at}

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Health systems invest in diabetes quality improvement (QI) programmes to reduce the gap between research evidence of optimal care and current care.1 Examples of commonly used QI strategies in diabetes include programmes to measure and report quality of care (ie, audit and feedback initiatives), implementation of clinician and patient education, and reminder systems. A recent systematic review of randomised trials of QI programmes indicates that they can successfully improve quality of diabetes care and patient outcomes.2 Changes in surrogate markers such as blood glucose control, blood pressure or cholesterol levels are used to measure QI intervention effectiveness.2

However, investments in QI strategies are only worthwhile if the programmes that effectively improve care are sustained after trial completion.3 Failure to maintain QI programmes contributes to substantial research waste, resulting in suboptimal patient care since the effective interventions are not available.4 5 Furthermore, failure to redirect resources from ineffective programmes creates opportunity cost. To date, no studies have examined the sustainability of rigorously evaluated diabetes QI programmes. The objective of this study is to explore factors associated with sustained implementation of diabetes QI programmes after cessation of their research funding.


In 2018, we emailed the authors of 226 trials on diabetes QI programmes and requested them to complete an online survey about their perceived sustainability of their intervention. These trials were published between 2004 and …

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  • ELK-H and HYY are joint first authors.

  • ELK-H and HYY contributed equally.

  • Contributors NMI has full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: JMG and NMI. Acquisition of data: ELK-H and HYY. Analysis and interpretation of data: ELK-H, HYY, SK, JG, and NI. Drafting of the manuscript: ELK-H and HYY. Critical revision of the article for important intellectual content: ELK-H, HYY, SK, CL, JG, and NMI. Statistical analysis: SK. Study supervision: JMG and NMI.

  • Funding JMG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. NMI holds a Canada Research Chair in Implementation of Evidence Based Practice.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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