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Improving Diabetes Outcomes by an Innovative Group Visit Model.

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Presentation on theme: "Improving Diabetes Outcomes by an Innovative Group Visit Model."— Presentation transcript:

1 Improving Diabetes Outcomes by an Innovative Group Visit Model

2 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

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

4 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)

5 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

6 Sample EMR History Screen

7 Sample Physical Exam Charting For EMR


9 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

10 Sample Characteristics A.A. White 31.8% 68.3% Male Female 18.1% 81.8% 30-4040-5050-60> 60 4.5 %22.7 %31.8 %40.9 % < 1 3-4 5-6 > 6 4.5 % 27.2% 63.6 % Race Gender AGE Years with D.M.

11 Clinical Results MeasurePrePostP value (paired t test) A1C9.25 8.17P=.009 Diastolic BP 82.81 77.14P=.002 Weight 240.00 236.90P=.001 LDL 82.6080.95P=.747 Beck13.7710.14P=.045 Hum SOSQ*85.8995.70P=.004 Org SOSQ*80.4888.09P=.052 Total SOSQ* 86.8492.26P=.028 Higher scores on the SOSQ = more satisfaction

12 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

13 Results of evaluations ExcellentVery GoodGoodFairPoor Ability to communicate clearly 21(95%)1000 Organization & preparedness 21(95%) 1 000 Ability to hold your interest 20(91%) 2 000 Handles difficult situations 21 (95 %) 1 000 Respects patients needs & differences 21 (95%) 1 000 Ability to keep session interactive 21 (95%)1000 How would you rate the facilitator in the following areas? N=22

14 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

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