Efficacy Study of Diabetes Group Visits
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.
|Study Design:||Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
|Official Title:||Initiating Diabetic Group Visits in Newly Diagnosed Diabetics in an Urban Academic Medical Practice|
- Change in Hemoglobin A1C [ Time Frame: baseline, 6 months, and 12 months ] [ Designated as safety issue: No ]
- Number of patients that are in compliance with all recommended preventive measures for diabetics [ Time Frame: baseline, 6 months, and 12 months ] [ Designated as safety issue: No ]Recommended preventive measures for diabetics include yearly foot exams, yearly eye exams, yearly microalbumin. This also includes yearly immunization with influenza vaccine and immunization with pneumococcal vaccine once before age 65 and once after age 65.
- Patient satisfaction with diabetes group visits [ Time Frame: 6 months and 12 months ] [ Designated as safety issue: No ]Will use validated tool: Diabetes Management Evaluation Tool
- Provider Satisfaction with Diabetes Group Visits [ Time Frame: baseline, 6 months, 12 months ] [ Designated as safety issue: No ]
- Difference in costs of delivering care to diabetics through group visits compared to standard individual medical appointments [ Time Frame: 6 months, 12 months ] [ Designated as safety issue: No ]
- Change in blood pressure [ Time Frame: baseline, 6 months, 12 months ] [ Designated as safety issue: No ]
- Change in LDL cholesterol [ Time Frame: baseline, 6 months, 12 months ] [ Designated as safety issue: No ]
|Study Start Date:||February 2012|
|Estimated Study Completion Date:||February 2013|
|Estimated Primary Completion Date:||February 2013 (Final data collection date for primary outcome measure)|
|No Intervention: Standard Individual Medical Appointment|
|Active Comparator: Group Visits||
Behavioral: Group Visits
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.
|Contact: Holly M Milne, MDfirstname.lastname@example.org|
|United States, Oregon|
|Oregon Health and Science University||Not yet recruiting|
|Portland, Oregon, United States, 97239|
|Contact: Holly M Milne, MD 503-494-8573 email@example.com|
|Sub-Investigator: Holly M Milne, MD|
|Principal Investigator:||Scott Fields, MD||Oregon Health and Science University|