Author:
Baig Arshiya A.,Staab Erin M.,Benitez Amanda,Hermans Sarah P.,Ham Sandra A.,Wan Wen,Campbell Amanda,Schaefer Cynthia T.,Quinn Michael T.
Abstract
Abstract
Background
Diabetes group visits (GVs) are a promising way to deliver high quality care but have been understudied in community health centers (CHCs), across multiple sites, or with a focus on patient-centered outcomes.
Methods
We trained staff and healthcare providers from six CHCs across five Midwestern states to implement a 6-month GV program at their sites. We assessed the impact of diabetes GVs on patient clinical and self-reported outcomes and processes of care compared to patients receiving usual care at these sites during the same period using a prospective controlled study design.
Results
CHCs enrolled 51 adult patients with diabetes with glycosylated hemoglobin (A1C) ≥ 8% for the GV intervention and conducted chart review of 72 patients receiving usual care. We analyzed A1C at baseline, 6, and 12 months, low-density lipoproteins (LDL), blood pressure, and patient-reported outcomes. GV patients had a larger decrease in A1C from baseline to 6 months (-1.04%, 95% CI: -1.64, -0.44) and 12 months (-1.76, 95% CI: -2.44, -1.07) compared to usual care; there was no change in blood pressure or LDL. GV patients had higher odds of receiving a flu vaccination, foot exam, eye exam, and lipid panel in the past year compared to usual care but not a dental exam, urine microalbumin test, or blood pressure check. For GV patients, diabetes distress decreased, diabetes-related quality of life improved, and self-reported frequency of healthy eating and checking blood sugar increased from baseline to 6 months, but there was no change in exercise or medication adherence.
Conclusions
A diabetes GV intervention improved blood glucose levels, self-care behaviors, diabetes distress, and processes of care among adults with elevated A1Cs compared to patients receiving usual care. Future studies are needed to assess the sustainability of clinical improvements and costs of the GV model in CHCs.
Funder
National Institute of Diabetes and Digestive and Kidney Diseases
Chicago Center for Diabetes Translation Research
National Institutes of Health
Publisher
Springer Science and Business Media LLC
Subject
General Medicine,Endocrinology, Diabetes and Metabolism
Reference24 articles.
1. Shi L, Lebrun LA, Tsai J, Zhu J. Characteristics of ambulatory care patients and services: a comparison of community health centers and physicians’ offices. J Health Care Poor Underserved. 2010;21(4):1169–83.
2. Forrest CB, Whelan E-M. Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians’ offices. JAMA. 2000;284(16):2077–83.
3. P Shin, J Sharac, Z Barber, S Rosenbaum, J Paradise. 2015. Community Health Centers: A 2013 Profile and Prospects as ACA Implementation Proceeds. The Henry J. Kaiser Family Foundation. Retrieved from http://kff.org/medicaid/issue-brief/community-health-centers-a-2013-profile-and-prospects-as-aca-implementation-proceeds/.
4. Department of Health and Human Services, Health Resources and Services Administration. Health Center Program: What is a Health Center?. Retrieved from https://bphc.hrsa.gov/about/what-is-a-health-center/index.html.
5. Department of Health and Human Services, Health Resources and Services Administration. Program Grantee Data. 2018 National Data. Table 7: Health Outcomes and Disparities. Retrieved from: https://bphc.hrsa.gov/uds/datacenter.aspx?q=t7&year=2018&state=&fd=. HRaSAHHCPTHOaDNDAa.