DISH: Evaluation of a diabetes group visit program

Diabetes mellitus is a prevalent chronic health condition. Those with diabetes must acquire self-efficacy in the tasks necessary for them to successfully manage their chronic condition. Traditional primary care practices will require innovative methods to succeed in providing effective services to the growing number of individuals with this condition who need knowledge, skills, and self-efficacy. A large urban family practice (35,000 patients and 2,300 diabetics) at Thomas Jefferson University in Philadelphia joined the Pennsylvania statewide chronic disease collaborative which encouraged use of the elements of the chronic care model to address diabetes. The planning group from the practice established a group visit program that included a check-in with a physician, an education session, and time set aside for self-management action planning. This one-stop-shop for diabetes meets weekly for 2.5 hours and is called Diabetes Information and Support for your Health or "DISH". About 500 patients have participated in this program to date. A group of patients with diabetes who attended the group visit program (N=52) were matched with a larger group of patients (N=236) who did not attend the group visit program. The program participants were matched to the comparison group based on age category, gender, race/ethnicity and zip code group, a surrogate marker for socioeconomic status. Key indicators were recorded for both intervention and comparison groups from before the group visit began and after it had been in operation for 6 months. Indicators included hemoglobin A1C, low density lipoprotein (LDL) levels, and blood pressure measurements. The distribution of demographic characteristics and co-morbidities were similar between the groups. The proportion of participants achieving an A1C concentration < 7% (CMH=4.6613, p=0.0309 (controlling for baseline A1C concentration) and a BP < 140/90 mm Hg (CMH=5.61, p=0.018 (controlling for baseline BP) increased significantly compared to the comparison group. The hemoglobin A1C concentration declined in 76.9% of the patients in the group visit program compared to 54.3% in the comparison group (CMH = 8.9911, p = 0.0027). The increase in the proportion of group visit participants achieving the target LDL concentrations did not achieve statistical significance. Early experience with the program was encouraging and suggested it may improve patients' management of their diabetes mellitus.