Improving Health Outcomes of People with Diabetes Mellitus ...
Improving Diabetes Outcomes by an Innovative Group Visit Model
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Transcript of Improving Diabetes Outcomes by an Innovative Group Visit Model
Improving Diabetes Outcomes by an Innovative Group Visit Model
Background
Group Visits incorporate elements of both a group educational visit PLUS an individual office visit1
Group Visits are one of the ten features of the establishment of a medical home said to impact outcomes the most1
Published studies on Group Visits currently show inconsistent clinical outcomes1
Most studies to date have been done in large university, veterans clinics or health maintenance organizations1
There is no established model for group visits, only general guidelines, making implication of this difficult in private practice1
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. White31.8% 68.3%
Male Female18.1% 81.8%
30-40 40-50 50-60 > 604.5 % 22.7 % 31.8 % 40.9 %
< 1 3-4 5-6 > 64.5 % 4.5% 27.2% 63.6 %
Race Gender
AGE
Years with D.M.
Clinical ResultsMeasure Pre Post P value
(paired t test)A1C 9.25 8.17 P= .009Diastolic BP 82.81 77.14 P= .002Weight 240.00 236.90 P=.001LDL 82.60 80.95 P= .747Beck 13.77 10.14 P= .045Hum SOSQ* 85.89 95.70 P= .004Org SOSQ* 80.48 88.09 P= .052Total SOSQ* 86.84 92.26 P= .028
Higher scores on the SOSQ = more satisfaction
Results of evaluations
Excellent Very Good Good Fair Poor
Content 21 (95%) 1 0 0 0
Handouts 18 (81%) 3 1 0 0
Smart Board 14 (67%) 6 2 0 0
Interactive Activates
15 (71.4%) 4 3 0 0
Motivational 17 (81%) 5 0 0 0
Overall Program
18(86%) 3 0 0 0
Interaction w others with
Diabetes
16 (71.4%) 5 1 0 0
Please rate each of the following aspects of the Diabetes Group Appointment n=22
Results of evaluations
Excellent Very Good Good Fair Poor
Ability to communicate
clearly
21(95%) 1 0 0 0
Organization & preparedness
21(95%) 1 0 0 0
Ability to hold your interest
20(91%) 2 0 0 0
Handles difficult situations
21 (95 %) 1 0 0 0
Respects patients needs &
differences
21 (95%) 1 0 0 0
Ability to keep session
interactive
21 (95%) 1 0 0 0
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