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