• Leif I Solberg, Kevin A Peterson, Helen Fu, Milton Eder, Rachel Jacobsen, and CarlinCaroline SCSUniversity of Minnesota, Minneapolis, Minnesota..
• HealthPartners Institute, Minneapolis, Minnesota leif.i.solberg@healthpartners.com.
• Ann Fam Med. 2021 Mar 1; 19 (2): 110-116.

PurposeThe 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.MethodsWe 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.ResultsThe 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.ConclusionsTop-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.© 2021 Annals of Family Medicine, Inc.

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