JMIR Publications

ABSTRACT

Background:

Gestational diabetes mellitus (GDM) is increasingly common with short and long-term health risks. The GooD4Mum pilot demonstrated quality improvements in general practice for care of patients after GDM. Building on the pilot, this project aimed to optimise provision of care by implementing and evaluating a program targeting identification, recall, screening and referral of patients after GDM within routine general practice.

Objective:

The study was designed to assess the effectiveness of Quality Improvement Collaborative (QIC) activities relative to usual practice for improving general practice clinicians’ provision of follow up and screening of patients with a history of gestational diabetes, to ultimately support prevention of onset of type 2 diabetes.

Methods:

A 21-month, prospective non-randomised controlled trial in primary care that compared a quality improvement collaborative (QIC) intervention to care-as-usual at the practice level, to review practice-level implementation, effectiveness and economic outcomes. Nine intervention practices were recruited and matched 1:1 with controls. For 18-months, the intervention practices engaged with the GooD4Mum QIC initiative including education, training, resources and quality improvement, using Plan-Do-Study-Act cycles. Control practices provided care as usual. A clinical decision support system aided identification, screening and tracking of patients with history of GDM. Intervention practices determined and established suitable improvement activities. Quantitative and qualitative data will be utilised, including quantitative data derived from practices periodically via automated data extraction. Implementation outcomes will be assessed through longitudinal qualitative interviews with practice leads, support staff and other stakeholders, guided by the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework.

Results:

The program ran in general practices between April 2024 and September 2025 with data collection continuing until the end of December 2025. Primary outcomes are the proportions of women with history of GDM in intervention and control practices who have recorded: type 2 diabetes mellitus (T2DM)-screening, modifiable cardiometabolic risk factors, referral to a diabetes prevention program. Secondary outcomes focus on professional practice improvement assessed via changes in processes of care, adherence to clinical standards and fidelity of intervention delivery. Detailed implementation process and economic evaluations will be conducted.

Conclusions:

The program proposes a novel quality improvement approach in primary care to optimise identification, screening and provision of lifestyle advice toward reducing onset of T2DM after GDM. Insights into primary care quality improvement processes and strategies to improve post GRM care are anticipated. Clinical Trial: On consultation with the University of Melbourne trials unit, this study did not meet the WHO/ICMJE 2008 definition of a clinical trial which prospectively assigns human participants to health-related interventions to evaluate the effects on health outcomes, so was not registered. This study focuses on influencing clinician knowledge and activity. Evaluating effects of the program on patient education or health outcomes was beyond the scope of the study.