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Group Visits for Treating Type 2 Diabetes in Hispanics [NIDDK]

Tamsen Bassford, MD

The overall goal of this project is to improve the delivery of care for diabetic patients and improve diabetic control (HbA1c) and control of common complications (e.g. risk factors for heart disease).  The standards for individual care are known, yet many clinics are not achieving them.  This project targets improving care through changing both the method of delivery of care for a majority of patients (GOV), and the overall culture of the clinic will necessarily change to support this shift.  The hypothesis is that interventions that occur at the whole clinic level, at the systems level, will be more effective for patients.  If the GOV is going to work within clinics, it will involve changes in the front desk, scheduling, nursing, physician orientation, etc.  To test this, we need a pilot feasibility phase (Phase I study) that will be organized around these issues, and will gain on the ground experience as to the shifts that need to occur.  This experience paves the way for designing the effectiveness trial (Phase II study), so that all relevant aspects of the protocol can be achieved.  It also points to issues of evaluation, since the implementation of GOV within a clinic is likely to also improve the care of those patients who, for whatever reason, do not participate in a GOV.