title: Diabetes specialty clinic:  an intervention to improve care for veterans.
abstract: OBJECTIVE
  People with diabetes who have chronically higher than normal blood glucose levels are at risk for a variety of health conditions, such as kidney failure, blindness, amputation, and a shortened life expectancy. At a Veterans Health Administration Medical Center (White River Junction, Vermont), a team of providers, diabetes educators, and psychologist noticed that patient education and therapy sessions were not effective for some patients and in addition the center had above the benchmark percentage of veterans who had higher than normal blood glucose levels. The team thought a new approach might work better and through feedback from staff and primary care providers developed the Diabetes Specialty Clinic (DSC). Our working theory was that veterans would make changes in diabetes self-management and improve their levels of blood glucose by sharing their experiences with other veterans in a supportive environment.
  
  
  METHODS
  Both quantitative and qualitative methods were used to evaluate whether the DSC had a positive impact with the veterans. Hemoglobin A1c was obtained at the first group meeting and at 6 weeks, 6 months, and 1 year, along with 5 patient-reported outcomes obtained using 4 questionnaires.
  
  
  RESULTS
  Thirty-nine veterans participated in the DSC. For the veterans who participated in the DSC for more than a year, 42% of the measures showed improvement, and they shared positive feedback on how the DSC influenced their behaviors by helping them engage in self-care activities.
  
  
  CONCLUSIONS
  The DSC seemed to be effective in creating a space for establishing relationships, resolving issues, and understanding the management of diabetes for veterans and health care professionals.
authors.affiliation: Leadership Preventive Medicine Residency Program, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. Karen.A.Homa@Hitchcock.org
authors.forename: Karen
authors.initials: K
authors.lastname: Homa
authors.forename: Mark
authors.initials: M
authors.lastname: Detzer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Morgan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Derry
authors.forename: Lou Ann
authors.initials: LA
authors.lastname: Merrill
authors.forename: Christina S
authors.initials: CS
authors.lastname: Whitley
authors.forename: Jason
authors.initials: J
authors.lastname: Aaron
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019982:Organizational Case Studies; D010353:Patient Education as Topic / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration*; D012944:Social Support; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014707:Vermont; D014728:Veterans