Efficacy Study of Diabetes Group Visits
Condition: Diabetes Mellitus, Type 2
MeSH terms: Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      Much evidence exists that new, more effective methods of delivering care to diabetics are
      necessary. In our current system of delivering care, diabetes care is often done in the
      context of multiple other issues addressed during a regular office visit. Providers often
      lack the time to properly educate patients on diabetes self management topics. This project
      hopes to show that group visits can improve clinical outcomes, patient satisfaction, provider
      satisfaction, and patient's self management knowledge, while decreasing cost. This group
      visit method can make care more patient-centered and team based which is in alignment with
      our organization's goal of becoming a true patient centered medical home. If successful, this
      could expand to our other family medicine clinic sites and provide a valuable learning
      opportunity for the family medicine residents at OHSU.

      The investigators will first identify newly diagnosed diabetics (diagnosed within the last 12
      months) at the South Waterfront and Gabriel Park family medicine clinics using EPIC. The
      investigators will invite those diabetics identified from the South Waterfront clinic to
      participate in 6 group visits that will follow a curriculum that the investigators created
      based on the National Standards for Diabetes Self Management Education and the ACP Diabetes
      Care Guide. This curriculum will address basic pathophysiology of diabetes, the "ABCs to
      Better Diabetic Care" as defined by the ACP Diabetes Care Guide, setting goals, nutrition,
      exercise, diabetic medications, and complications of diabetes. This intervention group will
      be compared to a control cohort identified at the Gabriel Park clinic that will continue to
      receive standard diabetes care from their primary physician. The investigators will look at
      and compare clinical outcomes (Hemoglobin A1C, blood pressure (BP), and LDL cholesterol
      levels), adherence to recommended preventive measures for diabetics (foot exams, eye exams,
      yearly microalbumin, and immunizations), patient and provider satisfaction, as well as cost.
      Cost data will be collected using EPIC to look at the costs involved in group visits compared
      to the cost of delivering diabetic care through the standard individual medical appointment.
      The investigators may also use EPIC to look at utilization of specialty services, emergency
      room visits, and inpatient admissions and compared utilization across groups.
    


Intervention name(s): Group Visits
Intervention type(s): Behavioral
Intervention description(s): During group visits, there will be discussions regarding the basic pathophysiology of diabetes, the "ABCs to Better Diabetic Care" as defined by the ACP Diabetes Care Guide, setting goals, nutrition, exercise, diabetic medications, and complications of diabetes. Patients will have blood drawn to measure hemoglobin A1C and lipids. They will be educated on self glucose monitoring so they will undergo finger sticks to measure their own glucose. BP measurements, monofilament foot exams, and urine collection for microalbumin will also occur during the study. They may also receive immunizations. A consent form for participation in the group visits, including undergoing the above procedures will be reviewed at our first group visit and signed by all participants.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Diabetes; Group Visit; Shared Medical Appointment