Improving Diabetes Outcomes by an Innovative Group Visit Model

Background  Group Visits incorporate elements of both a group educational visit PLUS an individual office visit 1  Group Visits are one of the ten features of the establishment of a medical home said to impact outcomes the most 1  Published studies on Group Visits currently show inconsistent clinical outcomes 1  Most studies to date have been done in large university, veterans clinics or health maintenance organizations 1  There is no established model for group visits, only general guidelines, making implication of this difficult in private practice 1

Research Question Can an innovative approach to group visits improve the clinical outcomes of patients with diabetes?

Methods  Records were reviewed to identify patients with A1C values of 7.5 or above (118/900 patients)  A focus group of 8 patients was done to identify interest and topics for group visit  A series of 3 group visits were done on a monthly basis with 22 patients divided into 3 separate groups  The group visit lasted 2 hours and was facilitated by the researcher using a curriculum she developed for the interactive white board (SMART Board)

Methods  The first hour was spent on interactive focused education and the second hour individual assessments/medical management done while the group still discussed and viewed additional educational material with the M.A. in attendance on the SMART Board  Visit one focused on healthy eating & understanding diabetes, visit 2 on exercise, medication & monitoring, visit 3 on coping and complications.  All participants had pre and post testing of A1C, LDL, Weight, BP, Beck Depression Index and the Seattle Outpatient Satisfaction Questionnaire

Sample EMR History Screen

Sample Physical Exam Charting For EMR

Sample Characteristics  The eligible patients were invited by a mailing, a notice in the office, phone calls & personal invitation by their physician or NP to join the group visits  The first 30 patients that agreed and signed consent form were included in the pilot program and divided into 3 groups  When the visits began there was 22/30 that actually participated

Sample Characteristics A.A. White 31.8% 68.3% Male Female 18.1% 81.8% > %22.7 %31.8 %40.9 % < > % 27.2% 63.6 % Race Gender AGE Years with D.M.

Clinical Results MeasurePrePostP value (paired t test) A1C P=.009 Diastolic BP P=.002 Weight P=.001 LDL P=.747 Beck P=.045 Hum SOSQ* P=.004 Org SOSQ* P=.052 Total SOSQ* P=.028 Higher scores on the SOSQ = more satisfaction

Results of evaluations ExcellentVery GoodGoodFairPoor Content 21 (95%)1000 Handouts 18 (81%)3100 Smart Board 14 (67%)6200 Interactive Activates 15 (71.4%)4300 Motivational 17 (81%)5000 Overall Program 18(86%)3000 Interaction w others with Diabetes 16 (71.4%)5100 Please rate each of the following aspects of the Diabetes Group Appointment n=22

Results of evaluations ExcellentVery GoodGoodFairPoor Ability to communicate clearly 21(95%)1000 Organization & preparedness 21(95%) Ability to hold your interest 20(91%) Handles difficult situations 21 (95 %) Respects patients needs & differences 21 (95%) Ability to keep session interactive 21 (95%)1000 How would you rate the facilitator in the following areas? N=22

Evaluation 20/22 (91%) said they would like to continue group visits 13/22 (61%) said they would like to continue monthly meetings 20/22 (91 %) participated in 3/3 (all) sessions 2/22 (9 %) participated in 2/3 sessions Having 3 groups running helped attendance as some would go to a different group