RESUMEN
BACKGROUND: Current diabetes management guidelines offer blueprints for providers, yet type 2 diabetes control is often poor in disadvantaged populations. The group visit is a new treatment modality originating in managed care for efficient service delivery to patients with chronic health problems. Group visits offer promise for delivering care to diabetic patients, as visits are lengthier and can be more frequent, more organized, and more educational. OBJECTIVE: To evaluate the effect of group visits on clinical outcomes, concordance with 10 American Diabetes Association (ADA) guidelines [American Diabetes Association, Diabetes Care, 28:S4-36, 2004] and 3 United States Preventive Services Task Force (USPSTF) cancer screens [U.S. Preventive Services Task Force, http://www.ahrq.gov/clinic/uspstf/resource.htm, 2003]. RESEARCH DESIGN AND METHODS: A 12-month randomized controlled trial of 186 diabetic patients comparing care in group visits with care in the traditional patient-physician dyad. Clinical outcomes (HbA1c, blood pressure [BP], lipid profiles) were assessed at 6 and 12 months and quality of care measures (adherence to 10 ADA guidelines and 3 USPSTF cancer screens) at 12 months. RESULTS: At both measurement points, HbA1c, BP, and lipid levels did not differ significantly for patients attending group visits versus those in usual care. At 12 months, however, patients receiving care in group visits exhibited greater concordance with ADA process-of-care indicators (p < .0001) and higher screening rates for cancers of the breast (80 vs. 68%, p = .006) and cervix (80 vs 68%, p = .019). CONCLUSIONS: Group visits can improve the quality of care for diabetic patients, but modifications to the content and style of group visits may be necessary to achieve improved clinical outcomes.
Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Hospitales de Práctica de Grupo , Cooperación del Paciente , Guías de Práctica Clínica como Asunto , Diabetes Mellitus Tipo 2/terapia , Femenino , Hospitales de Práctica de Grupo/tendencias , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendenciasRESUMEN
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Asunto(s)
Humanos , Enfermedades Hematológicas/diagnóstico , Microscopía Electrónica/tendencias , Cuerpo Médico de Hospitales/tendencias , Internado y Residencia/tendencias , Hospitales de Práctica de Grupo/tendencias , Técnicas Citológicas/tendencias , Investigación Biomédica/tendenciasAsunto(s)
Reestructuración Hospitalaria , Hospitales de Práctica de Grupo/organización & administración , Programas Controlados de Atención en Salud/organización & administración , Cronología como Asunto , Comercio , Comportamiento del Consumidor , Toma de Decisiones en la Organización , Hospitales de Práctica de Grupo/tendencias , LouisianaAsunto(s)
Administración Hospitalaria/tendencias , Hospitales de Práctica de Grupo/tendencias , Programas Nacionales de Salud/tendencias , Servicio de Enfermería en Hospital/tendencias , Predicción , Alemania , Humanos , Relaciones Interprofesionales , Garantía de la Calidad de Atención de Salud/tendenciasRESUMEN
One of our most distinguished physician-led medical institutions prepares for health care delivery in the 21st Century, embracing an aggressive strategy of vertical integration that is working. Here is a story that illustrates that market forces are the consumers' best friend.
