Winning the race against diabetes with shared medical appointments at the U.S. Department of Veterans Affairs

Abstract

Diabetes is a profound source of suffering for millions of people, as well as the seventh leading cause of death in the United States, resulting in 83,564 annual deaths (Mayer-Davis et al. 2017) Diabetes is more prevalent among US veterans at 25% compared to the general US population at 20% (Liu et al., 2017). The Veterans Health Administration (VHA) (2020) also reports that in addition to diabetes affecting 25% of the entire population of US veterans it is also the leading cause of blindness, end-stage renal disease, and amputation for VA patients. In 2001, the VHA added Type 2 diabetes to the list of health conditions caused by agent orange when it was used during the Vietnam War. Today, 270,000 Vietnam veterans are receiving disability payments for agent orange-related Type 2 diabetes (VHA, 2019). Shared medical appointments (SMAs) are a unique model of care delivery that provides an interactive setting to complete patient visits, improve access, enhance efficiency, promote peer support, build comradery, and most of all improve health outcomes. The purpose of this project was to utilize existing literature based on robust research regarding SMAs to assemble an interdisciplinary team, develop, launch, and land a 12-week diabetes SMA quality improvement project at the Montana VA--Great Falls Community Based Outpatient Clinic. This project aimed to utilize SMAs to improve six diabetes-related metrics, including hemoglobin A1 C, systolic blood pressure, low-density lipoproteins, body mass index, depression as measured by the patient health questionnaire 9 (PHQ-9) and patient satisfaction as measured by the diabetes treatment satisfaction questionnaire (DTSQ). The project resulted in clinical and statistically significant improvement in five of these metrics, making the project a best practice model of sustainable, innovative care delivery within the Veterans Administration.