RESidENcy PROGRAM Scholarly and Community Medicine Projects

Initiating Diabetes Group
Visits at Northeast Clinic
Jacqueline Redmer MD,MPH
Senior Night UW Family Medicine Residency Program
May 25 th , 2011
A History of Diabetes Group Visits
Model emerged 1990s with Kaiser
Permanente's efforts to serve a growing
number of chronic chronic-disease disease patients
receiving less face time with physicians
Rationale: patients patients with chronic disease
need more support and education because
they deliver most healthcare at home
Kaiser presented group visits with 20 20-25 25
patients, other models now include 3-15 3 15
patients varying in clinical services and
discussion format
RWJF Diabetes Initiative 2003
Evidence for Group DM Visits
Studies have shown improvement in A1C, BMI,
Lipids as well as increased adherence to ADA
guidelines (lab monitoring, ASA, foot exams),
evidence of cost containment, patient/provider
satisfaction, and education
Interventions vary in composition of providers,
group size, time length
Most significant improvements in metrics with
intensive behavioral health interventions
Riley et. al 2010, Trento et. al 2002, 2004, Bray 2005, Clancy 2007,
Sadur 1999, Pi-Sunyer X et. al 2007, Kirsh 2007, Davis 2008
Prevalence of Diabetes 2011
Diabetes affects 25.8
million people, or 8.3% of
the US population
Diagnosed 18.8 million,
undiagnosed undiagnosed 7 7.0 0 million
million
Risk of death 2 times that
of people similar age and
no diabetes
Total costs $174 billion,
direct medical $116
billion, indirect $58 billion
CDC National Diabetes Fact Sheet 2011
Group Visit Rationale
Innovative way to help diabetic patients
reach their goals, not the same as DE
Interactive education with components of
an individual patient p office visit
Stresses the importance of diabetes self-
management
Group visits more than lectures lectures-draw draw on
patient experience and emotion
Providers bill the same medical-
management codes
Creating a Group DM Visit at
Northeast Clinic
NE residents visited Verona Clinic and
used their group diabetes visit as template
Scheduling: All clinic schedules, EPIC
templates, templates templates, 90 90 minute minute visits
visits
Recruiting patients: Signs, diabetes
registry
Understanding pre-visit pre visit logistics
Coordinating follow-up: follow up: Labs, referrals
5/13/2011
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