Effects of Implementing Two Models of Diabetes Shared Medical Appointments on Patient Centered Care and Team Coordination

Abstract

<h3>Context:</h3> The Invested in Diabetes study is a cluster randomized pragmatic trial comparing two models of diabetes shared medical appointments (SMAs). <h3>Objective:</h3> To examine effects of condition on changes in patient centered chronic illness care and team coordination over time among practices randomized to one of two diabetes SMA models. <h3>Study Design and Analysis:</h3> Practices were randomly assigned to implement either patient-driven (PTD) or standardized (STD) diabetes SMAs. Diabetes care team members completed individual self-report surveys at baseline (T0), midpoint (T1; pre-COVID), and final follow-up (T2; during COVID). Descriptive statistics were used to assess mean scores over time. A difference-in-difference analysis using linear mixed effects models was used to test effects of condition on changes in outcomes. <h3>Setting or Dataset:</h3> 22 primary care practices in CO and MO. <h3>Population Studied:</h3> Diabetes care team members (e.g., health educators, providers). <h3>Intervention:</h3> The STD model involves delivery of an evidence-based curriculum by a health educator (HE). The PTD model involves a multidisciplinary care team approach including HEs, peer mentors, and behavioral health providers (BHP). Patients in both conditions have 1:1 visits by a prescribing provider (PP). <h3>Outcome Measures:</h3> Patient centered chronic illness care was measured using two domains of the Assessment of Chronic Illness Care (ACIC): Self-Management (SM) and Integration of Chronic Care (ICC); 11-point scale. Team coordination was measured using the Relational Coordination Survey (RCS); 5-point scale. <h3>Results:</h3> Across both conditions, mean ACIC-SM scores improved between T0 (M = 7.07) and T1 (M = 7.30) but worsened by T2 (M = 6.51). Similarly, ACIC-ICC scores improved between T0 (M = 6.36) and T1 (M = 6.63) but worsened by T2 (M = 5.83). Mean RCS scores somewhat improved between T0 to T1 across conditions (coordination with the SMAC: 3.20 to 4.29; HE: 3.81 to 4.17; BHP: 3.54 to 4.06; PP: 3.88 to 4.29) but worsened at T2 (SMAC: 3.85; HE: 4.01; BHP: 3.73; PP: 4.08). There was no significant effect of condition on changes in ACIC-SM, ACIC-ICC, or RCS scores at any time point (all p = ns). <h3>Conclusions:</h3> Implementing diabetes SMAs was generally associated with improved perceived patient centered care and team coordination, regardless of SMA model. Improvements were not sustained at final follow-up (during COVID), suggesting negative effects of the pandemic on quality of diabetes care.