Karen Holder, FNP – Clinician Lead for Shared Medical Appointment; Kelly McCue, BS, MPH - Diabetes Program

Coordinator; Jessica Chambers – Health Educator and Audrey Wall – Health Educator

• A shared medical model is being implemented in a rural clinic.

• Inclusion criteria: target population includes pregnant patients diagnosed with type 2 diabetes mellitus, gestational diabetes

and patients at risk of developing gestational diabetes.

• Exclusion criteria include a diagnosis of cognitive impairment, a psychiatric diagnosis of schizophrenia/psychosis and/or any

behavioral problem which might interfere with group

participation and discussion.

• Session format: a 4-week curriculum (every other week) developed in collaboration with the healthcare provider and

diabetes educator

• Each session is 2- 2.5 hours and includes a prenatal visit with

the healthcare provider; healthy snacks included

• The team members involved in SMA include

• Healthcare provider (lead)

• Program coordinator (diabetes educator)

• Two health coaches to co-facilitate the group

• A medical assistant to assist with documentation and charting

• The invitation is sent two weeks prior to the SMA session.

• HIPPA and voluntary disclosure of personal medical info in a group will be addressed in each session.

• Billing will be done individually for each patient as a CPT level 3 (99213) or 4 (99214) depending on the complexity of the

medical decision making (AAFP, 2017).

Methods

• The Chronic Care Model (CCM) of disease

management provides a useful framework for

establishing group shared medical

appointments.

Background and Significance

Format of Shared Medical Appointment

• The goal of this study is to develop and

implement a Shared Medical Appointment

(SMA) program for gestational diabetes patients.

• A group medical care model (SMA) is an

important inter-disciplinary care delivery

innovation to complement the individual

medical visit.

• SMAs focus on education for patients on their

chronic disease and enhancement of self-

management skills.

Purpose

• SMA model implementation date: March 31, 2017

• Review of literature demonstrates that SMA is an

innovative practice model that:

• increased patient satisfaction,

• improved clinical outcomes/ health behaviors,

• improved provider-patient relationships,

• improved quality of life,

• decreased emergency care visits,

• decreased referrals to specialists,

• improved medication adherence,

• increased self-efficacy.

•Outcomes to be measured:

• Clinical outcomes: blood sugar, blood pressure and weight gain

• Patient satisfaction and quality of life survey

•Conclusion: It is anticipated that the SMA program will improve gestational diabetes-related clinical

outcomes and quality of life and empower patients

to learn how to better care for themselves.

Summary/Implications

American Academy of Family Physicians. (2017). Coding for group visits. Retrieved from http://www.aafp.org/practice-

management/payment/coding/group-visits.html. American Diabetes Association. (2016). Standards of medical care in diabetes. Diabetes Care, 39(1). S1-112. Retrieved from

http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf Improving Chronic Illness Care (n.d.). The chronic care model. Retrieved from

http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2 Kirsh, S., Watts, S., Pascuzzi, K., O'Day, M.E., Davidson, D., Strauss, G., Kern, E., Aron, D.C. (2007). Shared medical appointments

based on the chronic care model: a quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk. Quality and Safety in Health Care, 16(5), 349-353. Retrieved from http://qualitysafety.bmj.com/content/16/5/349.long

Kirsh, S.R., Lawrence, R.H. & Aron, D.C. (2008). Tailoring an intervention to the context and system redesign related to the intervention: case study of implementing shared medical appointments for diabetes. Implementation Science, 3, 34-48. doi: 10.1186/1748-5908-3-34

Millermaier, E., Neuwirth, Z., Noffsinger, E. & Prescott D. (2009). Shared medical appointments: a proven health care delivery

model. Retrieved from: http://www.massmed.org/Continuing-Education-and-Events/Conference-Proceeding-Archive/Shared-Medical-

Appointments--Harvard-PPT-(pdf)/ Stellefson, M., Dipnarin,e K., & Stopka, C. (2013). The chronic care model and diabetes management in US primary care settings: a

systematic review. Preventing Chronic Disease, 10, 120180. doi: http://dx.doi.org/10.5888/pcd10.120180 Watts, S. A., Lawrence, R. H., & Kern, E. (2011). Diabetes nurse case management training program: enhancing care consistent with

the chronic care and patient-centered medical home models. Clinical Diabetes, 29(1), 25-33. doi: http://dx.doi.org.libproxy.nau.edu/10.2337/diaclin.29.1.25

References

Integrating the chronic-care model: implementation of shared

medical appointments for patients with gestational diabetes College of Health & Human Services - School of Nursing - Northern Arizona University

Despina Ciocanel, RN, BSN, MSBS, MADM

Kirsch et al., 2007

Acknowledgments

Improving Chronic Illness Care, n.d.

Session Curriculum Activity

Session 1. Introduction to

gestational diabetes

Diabetic A1c visuals

Fetal and placenta models

Session 2. Healthy eating in

gestational diabetes

Reading food labels

Sugar in beverages models

Session 3. Stress and exercise Types of physical exercises

(short practice)

Breathing exercise

Session 4. After pregnancy Measuring blood sugar

Delivery activity

Millermaier et al., 2009

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Non-SMA