Health Quality Ontario

Primary Care


Best Practices

Updated on November 17, 2015

“Insanity is doing things the way we’ve always done them and expecting different results”
Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.7 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.


Updated on November 17, 2015

“Some is not a number, soon is not a time.”
Don Berwick, former President and CEO of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Type of Indicator Indicator of Quality Improvement How to Calculate:


Targets/ Benchmarks How is This Indicator Used?
Outcome Percentage of patients with diabetes, aged 40 or over, with two or more glycated hemoglobin (HbA1c) tests within the past 12 months Number of patients with diabetes, aged 40 or over, with two or more glycated hemoglobin tests (HbA1c) within the past 12 months
Number of patients with diabetes aged 40 or over.

Equivalent measures are available for CHCs, nurse practitioner-led clinics and AHACs, extracted from electronic medical records (EMRs)
Targets: As high as possible (set by individual practices)

Provincial benchmarks:
not available
Quality improvement

QIP indicator

Run Charts

Collected measures can be presented graphically by plugging the monthly results into run chart.

Tools & Resources

Updated on November 17, 2015


QI Tools

For a more comprehensive list of tools and resources, visit the following links on our HQO website:



Updated on November 17, 2015


Diabetes is a complex disease that can be a challenge to manage. In 2012, 6.5% (1.9 million) of Canadians aged 12 or older reported that they had diabetes.1 The prevalence of diabetes is typically lower in wealthier countries when compared to low- or middle-income countries.2 However, among OECD ( Organisation for Economic Co-operation and Development) member countries, Canada has one of the highest rates of diabetes at 9.2% (Figure 1).3

Many Canadians with diabetes will develop serious, potentially fatal diabetes-related complications including heart disease and stroke, visual impairment, kidney disease, foot ulcers, and amputations).2 Diabetes is managed by keeping blood sugar under control and this is the key to avoiding complications and discomfort.

Call to Action

Optimal glycemic control is fundamental to managing diabetes. Measuring HbA1c (haemoglobin A1c) determines average blood sugar levels and higher levels can indicate a greater risk for developing diabetes-related complications.

It is a valuable indicator of treatment effectiveness and testing at 6-month intervals is recommended when glycemic targets are consistently achieved.4 A recent study on a large multicentre data set (400,497 tests in 79,409 patients, 2008-2011) showed that the optimal testing frequency was 4 times per year.5

  1. Statistics Canada

    Diabetes, 2012.
    Available from:

  2. Canadian Diabetes Association

    Diabète Québec. Diabetes: Canada at the Tipping Point. Charting a New Path. 2011.
    Available from:

  3. International Diabetes Federation

    Diabetes Atlas. 2009.
    Available from:

  4. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

    Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2013;37(suppl 1):S1-S212.

  5. Driskell OJ, Holland D, Waldron JL, Ford C, Scargill JJ, Heald A, Tran M, Hanna FW, Jones PW, Pemberton RJ, Fryer AA.

    Reduced testing frequency for glycated hemoglobin, HbA1c, is associated with deteriorating diabetes control. Diabetes Care. 2014 Oct;37(10):2731-7.