Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Health and Rehabilitation Sciences


Sibbald, Shannon L.


Team-based care is widely used in primary care to help manage complex chronic conditions; yet little is known about how to spread evidence-based models to new contexts. This research explored the impact of context on the spread of an integrated, team-based program for COPD in primary care, known as Best Care COPD (BCC). This research used a qualitative collective case study approach guided by a constructivist paradigm. The results highlighted that some care settings presented challenges, however the providers were able to overcome these barriers and only required minor adaptations primarily in day-to-day processes. The BCC program was able to balance program fidelity with adaptability to ensure that the program was successful as it spread to different sites with unique contexts. This study provided insight into how to support the spread of BCC and other chronic disease management programs in primary care through an understanding of context. Supporting the spread of successful programs will enable appropriate care for a greater patient population.

Summary for Lay Audience

Team-based care has been recognized as an effective way to manage complex health conditions. Team-based care involves collaborating with providers across different areas of healthcare with the goal of keeping patients at the centre of their care. However, even though a program may be successful in one context, it may not have the same success when implemented elsewhere. Despite an agreement on the value of team-based healthcare programs, there is limited understanding on how these programs can expand from site to site and how the context of the site can impact the implementation of a program.

Our study explored the Best Care COPD (BCC) program. BCC is a team-based program that focuses on the management of Chronic Obstructive Pulmonary Disease (COPD), a complex and progressive disease. As the program has expanded to different contexts, this research sought to understand how the context at the site has impacted the expansion of the program. This research incorporated multiple data collection tools with healthcare providers involved with the delivery of BCC.

The findings from this research highlighted that the BCC program has been able to spread to different contexts while only experiencing minor challenges so far. Participants often expressed that these challenges have been overcome by the flexibility of the BCC provider. However, adapting the program to the unique site runs the risk of altering the outcomes of the program. The BCC program mitigated this risk by involving primary care providers directly in the initial planning phases as to anticipate specific challenges that may arise as the program spread to new primary care contexts. Incorporating a dynamic understanding of context into the program design from experts in the new setting allowed for continued growth with consistent outcomes.

This research provides insight into how BCC can expand to more contexts with varying needs. These findings have the potential to help support the spread of other chronic disease management programs with similar care characteristics to COPD. It is important to explore how these successful programs can expand to new sites and in turn, help more patients access appropriate care for their condition.