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BACKGROUND/RATIONALE:
Background:
Diabetes is a national problem whose management complexity threatens to overwhelm the acute care-oriented health care system while it also challenges the resources of individual primary care providers. Management strategies to improve diabetes care and train or re-train clinicians are needed. In order to equip any level physician with resources to effectively and efficiently manage chronic care, implementation of such resources needs to be examined to develop a model that can be tailored to suit individual facility needs. In the last two years, we have been successful in implementing a diabetes shared medical appointment (SMA) based on the chronic care model. Our current system redesign provides quality care, supports the primary care providers and trains medical residents. SMAs offer the potential to provide training in crucial skills that have to date remained less amendable to traditional educational practices.
OBJECTIVE(S):
Objectives:
The proposed study seeks to develop and evaluate the implementation of an SMA training toolkit at a community based outpatient clinic site and identify enabling, facilitating, and inhibitory factors related to implementation (Aim 1), and to provide data regarding the impact participating in SMAs has on training physicians to attain competency in management of diabetes (Aim 2).
METHODS:
Research Plan:
Focus groups and mixed methods will be used for Aim 1 and prospective pre-post, mixed-methods design with a non-randomized comparison group of residents and medical students for Aim 2.
Methodology:
For Aim 1: We will iteratively develop a toolkit based on 2-year experience with Diabetes SMAs professional participants via 2 focus groups. The manual will include a template to guide practical application of the Diabetes Cube in identification of high risk patients. We will compare the DM Cube’s performance to that of our comprehensive local diabetes registry.
We will evaluate the completeness of the toolkit via the implementation of diabetes SMAs in 1 CBOC of medium size. A formative evaluation of SMA implementation will be used with a mixed-method approach (questionnaires, direct observation, and semi-structured interviews) of patients and staff and short term results of intermediate clinical outcomes (A1c, systolic blood pressure, and ldl-cholesterol).
For Aim 2: Four groups of trainees will be asked to complete structured questionnaires: 1) residents assigned to diabetes SMAs; 2) medical students who are assigned to observe SMAs; 3) residents and 4) medical students who do not experience SMAs during the study period. All participants will complete questionnaires (self-administered) at baseline and then four weeks later after experiencing 4 SMAs or other learning activities (post-assessment). The questionnaires will assess beliefs about barriers to self-care for patients, attitudes toward diabetes and its treatment, and the importance of and confidence in various skills used in the diagnosis and treatment of patients with chronic illness. In-depth interviews will be conducted with some participants. These interviews will be conducted prior to participating in the SMAs or other training experiences and after the post-assessment of attitudes and beliefs, and will build on the quantitative instruments to gain insights into additional, relevant issues. It is hypothesized that experiencing SMAs will be associated with more favorable attitudes and beliefs about diabetes and its management. Data analysis will include analysis of variance to compare groups and qualitative analysis of interviews to identify common and unique themes.
FINDINGS/RESULTS:
Findings:
None to date.
IMPACT:
Clinical Impact:
Diabetes is a national problem that has reached epidemic proportions. Its management complexity threatens to overwhelm the acute care-oriented health care systems. SMAs are proving to be a successful approach to the delivery of quality chronic illness care. The findings related to both aims will help us to further refine our training materials for implementing SMAs. Moreover, our project will be one means of facilitating the rollout of the DM Cube by providing specific templates for its use to identify high risk patients that would benefit from further intervention.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Resource Use and Cost, Treatment
Keywords:
Diabetes, Care Management
MeSH Terms:
none
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