JMIR Publications

ABSTRACT

Background:

Gestational diabetes mellitus (GDM) is increasingly common with short and long-term health risks including progression to type 2 diabetes. Building on the GooD4Mum pilot, which demonstrated quality improvements in general practice for care after GDM, this project implemented and evaluated a primary care Quality Improvement Collaborative (QIC) program to optimise identification, recall, screening and referral of patients after GDM.

Objective:

To assess the effectiveness of QIC activities relative to usual practice for improving general practice clinicians’ provision of follow-up and screening of patients with a history of GDM, to ultimately support onset of type 2 diabetes.

Methods:

A 21-month, prospective non-randomised controlled trial at practice level, matching intervention practices 1:1 with controls. The QIC intervention is compared to care-as-usual in general practice to review implementation, effectiveness and economic outcomes. For 18-months, the intervention practices engaged with the GooD4Mum QIC program including education, training, resources and Plan-Do-Study-Act cycles to implement locally relevant improvement activities. A clinical decision support system aided identification, screening and tracking of patients with history of GDM. Control practices provided care as usual. Primary outcomes are practice-level proportions of women with recorded: type 2 diabetes screening, modifiable cardiometabolic risk factors, and referral to a diabetes prevention program. Secondary outcomes examine changes in care processes, adherence to clinical standards, and fidelity of intervention delivery. Outcome analyses use clinical data derived from practices via automated extraction. Baseline comparisons use t-tests or chi-squared tests. Primary and secondary outcomes are analysed by repeated measures analysis of variance and/or cluster-adjusted generalised estimating equations, accounting for practice-level clustering and sensitivity analyses includes a per-protocol approach. Implementation outcomes are assessed through longitudinal qualitative interviews with practice leads, support staff and stakeholders, guided by the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. Cost-consequence analysis uses clinical activity and practice-reported data.

Results:

The program ran in nine general practices between April 2024 and September 2025 with data collection until December 2025. Practice characteristics and protocol deviation are summarised. Detailed outcome, cost-consequence and implementation process evaluations will be reported elsewhere.

Conclusions:

The protocol offers a novel quality improvement approach enhanced by clinical decision support and automated data extraction, to optimise identification, screening and provision of lifestyle advice toward reducing type 2 diabetes after GDM. The evaluation is designed to generate actionable insights and a scalable implementation toolkit to improve care after gestational diabetes. 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 and was not registered. This study focuses on influencing clinician knowledge and activity rather than prospectively assigning participants to health-related interventions to evaluate patient health outcomes.