title: Improved glycemic control in veterans with poorly controlled diabetes mellitus using a Specialty Care Access Network-Extension for Community Healthcare Outcomes model at primary care clinics.
abstract: BACKGROUND
  An increasing number of patients with diabetes mellitus has created a need for innovative delivery of specialized care not only by diabetes specialists but also by primary care providers (PCPs) as well. A potential avenue to address this need is training of PCPs by specialists via telehealth. The Veteran Affairs (VA) Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) program includes education and case-based learning for PCPs by a multidisciplinary specialty team utilizing videoconferencing technology.
  
  
  METHODS
  Two PCPs completed a year of SCAN-ECHO diabetes training. These two PCPs set up "diabetes mini-clinics" to treat difficult-to-control high-risk patients with diabetes mellitus from their own panel and from their colleagues in the same community-based outpatient clinic (CBOC). We utilized a retrospective program evaluation by t-test using pre/post glycated hemoglobin (HbA1c) lab values after being seen by the two PCPs.
  
  
  RESULTS
  A total of 39 patients, all with HbA1c > 9.0%, were seen in the two PCP mini-clinics over 15 months. The mean HbA1c improved from 10.2 ± 1.4% to 8.4 ± 1.8% (p < 0.001) over the average follow-up period of five months. This was not explained by system-wide changes or improvements.
  
  
  CONCLUSIONS
  Care of veteran patients with poorly controlled diabetes by PCPs who participated in SCAN-ECHO program leads to improvement in glycemic control. This model of health care delivery can be effective in remote or rural areas with limited availability of specialists.
authors.affiliation: Endocrinology Section, Louis Stokes Cleveland VA Medical Center, USA Sharon.Watts@va.gov.
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Watts
authors.affiliation: Psychology Section, Louis Stokes Cleveland VA Medical Center, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Roush
authors.affiliation: Nutrition and Food Section, Louis Stokes Cleveland VA Medical Center, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Julius
authors.affiliation: Endocrinology Section, Louis Stokes VA Medical Center, USA Case Western Reserve University, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Sood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000379:methods / Q000458:organization & administration; D003920:Diabetes Mellitus / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008875:Middle Aged; D017146:Models, Organizational; D010353:Patient Education as Topic / Q000379:methods; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D058996:Quality Improvement; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans; D049269:Videoconferencing
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Diabetes; primary care; quality improvement