A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes
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Case Western Reserve University School of Graduate Studies / OhioLINK
2013
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| Online Access: | http://rave.ohiolink.edu/etdc/view?acc_num=case1374523214 |
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ndltd-OhioLink-oai-etd.ohiolink.edu-case13745232142021-08-03T06:18:40Z A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes Harris, Marianne DeMeo Nursing Health Health Care Shared Medical Appointments SMA Group Medical Visits Type 2 Diabetes Clinical Outcomes Quality Outcomes Veterans A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 DiabetesAbstract by MARIANNE DeMEO HARRISThe Center for Disease Control (CDC) reports that chronic disease accounts for more than 75% of the nation's $2 trillion in medical care costs, and the direct and indirect costs of a chronic disease such as diabetes alone is estimated at $174 billion dollars a year. Diabetes and heart disease frequently occur reciprocally because over time, elevated blood sugar levels lead to microvascular alterations in the intimal layer of the blood vessels. Despite the serious risks of these two medical conditions, our current health care system has yet to develop effective strategies for managing diabetes, and minimizing heart disease risk. One model of care that shows promise, however, is shared medical appointments (SMA), also known as group medical visits where a multidisciplinary team of health professionals provide health care to a cohort of patients at the same time in a supportive, educational, and interactive environment. There are a limited number of studies on utilizing shared medical appointments to manage diabetes and heart disease, and most show mixed results. Therefore, the author proposed to continue to build evidence on this topic and promulgates the following hypothesis: Compared to veterans who receive usual care (UC), (n=617) veterans with type 2 diabetes who utilize shared medical appointments (n=371) will have significantly better clinical outcomes, and higher levels of provider adherence to accepted VA Department of Defense (DoD) diabetes clinical practice guidelines. This 3-year retrospective two-group observational study utilized an existing Veterans Administration (VA) VISN 10 database warehouse, and Computerized Patient Record System (CPRS). Emergency room data was also abstracted retrospectively over the same 3-year study period. Additional co-morbidities that were tracked included hypertension, dyslipidemia, coronary artery disease, and obesity, as well as demographic variables such as age, sex, marital status, and gender. Three moderator variables were tracked in the study: the presence of a mental health diagnosis, number of health care visits (UC and SMA) and participation in other VA self-management programs over the three-year study period. The study variables were analyzed using t-tests, X2, repeated measures ANOVA, and multiple regression to reveal the relationships among the variables. The clinical outcome variables of HbA1c, lipid panel and blood pressure were not significantly different in the SMA cohort over UC during the three year study period; however, several clinical practice guidelines were met annually for the SMA veterans that included having an angiotension-converting enzyme inhibitor/angiotension-receptor blockers and aspirin prescribed and having annual ophthalmology and podiatry exams. This research project enhances our knowledge on how using SMAs may produce improved provider adherence to diabetes care quality standards in veterans with type 2 diabetes who are at substantial risk for cardiovascular disease 2013-08-23 English text Case Western Reserve University School of Graduate Studies / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=case1374523214 http://rave.ohiolink.edu/etdc/view?acc_num=case1374523214 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws. |
| collection |
NDLTD |
| language |
English |
| sources |
NDLTD |
| topic |
Nursing Health Health Care Shared Medical Appointments SMA Group Medical Visits Type 2 Diabetes Clinical Outcomes Quality Outcomes Veterans |
| spellingShingle |
Nursing Health Health Care Shared Medical Appointments SMA Group Medical Visits Type 2 Diabetes Clinical Outcomes Quality Outcomes Veterans Harris, Marianne DeMeo A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes |
| author |
Harris, Marianne DeMeo |
| author_facet |
Harris, Marianne DeMeo |
| author_sort |
Harris, Marianne DeMeo |
| title |
A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes |
| title_short |
A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes |
| title_full |
A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes |
| title_fullStr |
A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes |
| title_full_unstemmed |
A Retrospective Study Comparing Shared Medical Appointments with Usual Health Care on Clinical Outcomes and Quality Measures in Veterans with Type 2 Diabetes |
| title_sort |
retrospective study comparing shared medical appointments with usual health care on clinical outcomes and quality measures in veterans with type 2 diabetes |
| publisher |
Case Western Reserve University School of Graduate Studies / OhioLINK |
| publishDate |
2013 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=case1374523214 |
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