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BACKGROUND/RATIONALE:
Enter text here.
OBJECTIVE(S):
While medical training has increasingly included chronic care management, quality care necessitates education approaches that go farther. In April 2005, the Louis Stokes Cleveland VAMC implemented a weekly Diabetes Shared Medical Appointment (SMA). Our recently published initial results and updated information for 334 patients documented improved results that have been sustained. As such, SMAs offer an important opportunity to improve chronic care and a unique setting for training physicians. In order to equip physicians with needed resources to manage chronic care, the ways in which SMA experiences are processed and integrated into learning about interdisciplinary approaches and expanding trainees' understanding of chronic care issues need to be examined. Building on previous pilot work, the proposed pilot project includes using a think-aloud protocol to evaluate and validate new items and scales assessing interdisciplinary team and chronic care/diabetes beliefs, and evaluating and adjusting direct observation coding tools for chronic condition care. Modifications to an existing approved IRB protocol have been submitted. text here.
METHODS:
Specific Aim 1: Evaluate the impact of SMAs on residents' and medical students' confidence, attitudes, comfort and beliefs regarding chronic care issues and management of diabetes compared to other ambulatory training experiences. Method: Pre-post design with trainees (12 in each of 3 groups) asked to complete structured questionnaires. In-depth post-only interviews (30-minutes in length) will be conducted with 3 randomly selected members from each group of participants (total interviews equals 9). The think-aloud protocol will be used for new items and participants will be asked to dialogue about what they are thinking, focusing on, feeling and doing internally as they read the items and respond.
Specific Aim 2: To assess the feasibility of using direct observation to accurately measure and compare time utilization patterns and diabetes management issues covered by trainees during patient encounters, and to identify how traditional encounters with patients with diabetes differ from encounters with patients as part of the Diabetes SMA experience, and to assess what components may change over time. Method: Direct observation coding will be used to accurately measure process and content of patient-resident encounters, both traditional encounters and SMA-one-on-one encounters. During SMAs, after the group session, each patient is seen individually by a provider. The observer will randomly select 6 residents to follow during clinic time, divided evenly between traditional and SMA-linked encounters with patients with diabetes.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Our overall goals are to improve quality care that we provide Veterans with chronic conditions, in general, and diabetes specifically. SMAs are proving to be a successful approach to the delivery of quality chronic illness care. It is essential that we understand all the ways that SMAs improve diabetes management, including through linking quality training to quality care. As such our next step is to develop merit and SDP applications to evaluate the links between quality training and quality care for chronic conditions. Thus, our work will contribute directly to two priority areas: complex, chronic condition care, and health profession education and outcomes.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Communication and Decision Making, Treatment
Keywords:
Outpatient, Education Research, Trainees
MeSH Terms:
none
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