Please select the eligibility criteria that correspond to the clinical trial below.
Title: Can Group Visits Improve Outcomes of Veterans With Diabetes
Brief Summary: Background: Diabetes is a common, morbid and expensive disease among veterans. Achieving adequate glycemic control and blood pressure control can reduce the devastating complications of diabetes. Because the majority of patients do not achieve adequate control of blood sugar and blood pressure, innovative strategies to improve control are needed. One strategy with great potential for veterans receiving VA care is the group clinic. Group clinics have been developed over the last 5-10 years, and have been shown to improve clinical outcomes and reduce outpatient utilization in geriatric settings. Group medical clinics involve a cohort of 8-20 patients who have 1-2 hour group visits. These clinics are distinguished from traditional group education visits for diabetes by the fact that these visits involve one physician and one or more additional health care professionals, usually a nurse practitioner and/or a pharmacist, and are designed to make management changes for a number of people with the same disease in a short period of time. The effect of group medical clinics on blood sugar, blood pressure, and the cost of diabetes care, is unknown. Objectives: Our primary objectives in this project are to determine the effectiveness and cost-effectiveness of a group visit intervention in improving rates of control of diabetes and high blood pressure in patients with both illnesses.


Options:
A: Inclusion Criteria:

* Men and women age 18 years or older,
* Ability to understand and read English,
* Be empanelled to one of the target PCMH sites, and
* Diagnosed with type 2 diabetes.

Exclusion Criteria:

* pregnant women,
* non-English speaking patients,
* receiving hospice care,
* active cancer and treatment with chemotherapy or radiation therapy,
* taking Coumadin,
* recipient of gastric bypass or similar procedure,
* diagnosis of uncontrolled hypothyroidism,
* known Cushing's syndrome,
* being treated with oral steroids,
* known liver disease,
* current diagnosis of cognitive impairments which would interfere with use of technology,
* congestive heart failure New York Heart Association class 3 or 4,
* inability to use a mobile device due to cognitive or physical impairments, and
* PAM® score = 4 during initial screening.
B: Inclusion Criteria:

* Primary care at one of two participating sites,
* HbA1c \>= 7.5%, Systolic BP \> 140 OR Diastolic BP \> 90 on 2 consecutive measurements

Exclusion Criteria:

-Primary care provider excludes patient from study, -Patient states that primary care is shared with non-VA primary care provider, -New enrollment in endocrine clinic within the last 6 months, -Patient is reluctant to participate in group visit for any reason, -Reduced life expectancy, as determined by any of the following: -New York Heart Association Class IV congestive heart failure, -Lung disease requiring supplemental oxygen, -End-stage renal disease on dialysis, -Current malignancy with any evidence of disease or currently undergoing chemotherapy or radiation therapy, -Cirrhosis of the liver, or -AIDS (HIV disease does not exclude a patient in the absence of an AIDS diagnosis), -Five or more errors on Short Portable Mental Status Questionnaire, Psychotic illness with hospitalization within three years prior to enrollment
C: Inclusion Criteria:

* Alive on 1 July 2009 with prevalent diabetes

Exclusion Criteria:

* Age \<= 39
* Residing in long-term care

Secondary Analysis:

* Analysis will be repeated using all people alive on 1 July 2009 without prevalent diabetes using the same exclusion criteria, to determine the spill-over effect of the Intervention on physicians' other patients.
D: Inclusion Criteria:

* The intervention-study comprises 40 general practices were:

  1. more than 50% of the patients with type 2 diabetes, who had participated in diabetes-consultations during the last year from the invitation-date to the project, were seen by a nurse at least once, stated by the practice. The diabetes-consultation should not only include examinations (blood tests and blood pressure measurement), but should also include communication about living with type 2 diabetes ;
  2. enrollment in the project before registration deadline (three weeks after invitation).

Patients with diabetes, alive and affiliated the practices by May 2011, were identified in a a validated diabetes database based on health registers; The national Patient Registry, The national Health Insurance Service registry, the prescription database and the laboratory database in the county.

Answer: B