title: Shared medical appointments for patients with diabetes: glycemic reduction in high-risk patients.
abstract: OBJECTIVE
  To assess the impact on glycemic control (A1c, %) in a primary care urban Veterans Affairs (VA) shared medical appointments (SMAs).
  
  
  METHODS
  A retrospective pretest/posttest study included all patients who had attended ≥1 SMA from 4/06 to 12/10. A1cs 810 days pre- and postinitial SMA were obtained from 90-day time periods. A1c levels were averaged within patient in these 90-day intervals and data were aggregated based upon corresponding time intervals.
  
  
  CONCLUSIONS
  Of 1290 individuals seen in SMAs, 1288 (99.8%) had ≥1 A1c levels and 1170 (90.7%) individuals had ≥1 level collected both before and after attendance. The sample was predominantly (96%) male and middle aged or older (mean [±1 SD] age of 62.6 + 9.09 years) with a mean Diabetes Severity Index 3.01 (2.34). There were significant A1c reductions (∼1%) in A1c overall (n = 1170) and for patients with ≥1 measurement in the 180-day periods preceding and following their first SMA appointment (n = 815). Linear regression analysis showed a significant (p < .001) pre-SMA positive trend (r(2) = 0.90).
  
  
  CONCLUSIONS
  Limitations notwithstanding (single site and design lacking a control group), the large number of patients demonstrates SMA clinical effectiveness in improving A1c for high-risk patients with diabetes.
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.|Case Western Reserve University, Cleveland, Ohio.
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Watts
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.|Case Western Reserve University, Cleveland, Ohio.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Strauss
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Kristina
authors.initials: K
authors.lastname: Pascuzzi
authors.affiliation: Boston Veterans Affairs Medical Center, Boston, Massachusetts.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: O'Day
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Kevin
authors.initials: K
authors.lastname: Young
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.|VA HSR&D/VA Office of Specialty Care Transformation Evaluation Center, Cleveland, Ohio.|VA HSR&D Diabetes Quality Enhancement Research Initiative Diabetes Center, Cleveland, Ohio.
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
authors.affiliation: Case Western Reserve University, Cleveland, Ohio.|Office of Primary Care, Patient Care Services, Washington, DC.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Kirsh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D005260:Female; D006297:Health Services Accessibility; D006755:Hospital Shared Services; D006787:Hospitals, Veterans; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D009820:Ohio; D057184:Practice Patterns, Nurses'; D012189:Retrospective Studies; D014504:Urban Health; D014728:Veterans
chemical_list: D007004:Hypoglycemic Agents
keywords: Diabetes; group medical appointments; primary care; quality improvement