Diverse Teams Research Articles

A Framework for Bariatric Surgery Patient Care: Patient and Professional Perceptions

Abstract Introduction A multidisciplinary health team for perioperative care of the bariatric patient, sustained in a viable framework to support a long-term follow-up service, may decrease rates of complications, help the recognition of the complexity of this chronic disease, and provide a comprehensive bariatric surgery process analysis. This study aimed to analyze patients’ and professionals’ experiences with the perioperative care process and identify their perceptions of the bariatric surgery process to support the long-term management of obesity surgical treatment. Methods This qualitative study was conducted in a bariatric surgery center in south Portugal. Seven health professionals participated in one focus group, and sixteen patients participated in one of the three focus groups. Patients’ focus group script had eleven open main questions with follow-up questions to probe for more information, addressing motivations, experiences with the pre-surgery and post-surgery process, and perceptions of lifestyle changes. Results Participants reported the need for a reference professional in the hospital to contact, the importance of psychological support to help patients deal with the ‘ups and downs’ of post-surgery life, and the financial support for physical activity programs. Conclusions This research helped identify a need for a framework for long-term follow-up and showed priorities to tailor health services for managing bariatric surgery patients. New bariatric surgery programs should incorporate a diverse health team, focusing on patient support in the long-term follow-up. This team should be led by a dedicated case manager and include physical activity specialists. Key messages • The positive effects of bariatric surgery go beyond weight loss, reinforcing the importance of developing a new conceptual framework based on a patient-centered care model. • A case manager specialist on the bariatric surgery process may be the key to improving the long-term benefits of bariatric surgery.

Diversity challenges in German nursing teams: a participatory organizational development approach

Abstract Background Migration of health care professionals, demographic change and the transformation of the health care system result in highly diverse nursing teams in German hospitals and nursing homes. Different orientations (regarding qualification, generation or migration background) collide in a working environment characterized by staff shortage, time pressure and decisions about life and death. But team cooperation not only has a strong impact on patient safety, but on job satisfaction and therefore retention management. Little is known on how teams cope with diversity challenges and how this is linked with organizational structures. Methods Based on qualitative content analysis of 197,5 hours of participatory observation, 8 group discussions and 25 interviews in 6 nursing teams in 2 hospitals and 2 nursing homes situated in a major German city, we developed workshops on the topic of team diversity and cooperation. 10 workshops (4-16 participants each) were in held in 2023/24 both on team- and management-level. Results All teams are struggling with diversity-related problems, but in their specific ways, depending on the particular neighbourhood of the facility and team composition among other things. Due to the strong team spirit and identity, the teams have a fundamental tendency to integrate diverse perspectives and orientations. But they need time capacities and supportive organizational structures. The workshops created a space to discuss the team specific problems. Starting points for structural changes could be identified and further discussed in the workshops at the next higher hierarchical level. Conclusions Organisational structures provide the framework conditions that enable teams to integrate different perspectives resulting from diversity in a productive way. One-fits all solutions are not suitable to address those problems and improve teamwork. A participatory bottom-up process seems to be the most appropriate approach. Key messages • Institutions need to provide structures in which diversity is not perceived as an additional burden. • The best way to initiate improvements is through a participatory bottom-up approach.

What works in global health partnerships? Reflections on a Nigerian-German project collaboration

Abstract Background Global health partnerships for project implementation is a frequent way to address health challenges. Bringing stakeholders from different disciplines, professions, settings and countries together provides opportunity to look at health challenges from different perspectives, develop suitable ideas to tackle them and leverage diverse capacities. Problem In such diverse partnerships, cultural norms, practical realities and institutional practices create challenges for the development of good and equitable relationships. Methods In our project collaboration between the Nigerian Centre for Disease Control and Prevention and the German Robert Koch Institute on developing and implementing trainings in infection prevention and control, we demonstrated how a partnership can function. The collaboration followed a participatory approach and was informed by the following principles: - Plan, revise, adapt and implement all project activities as well as its contents participatorily; - A well-coordinated teamwork is key to facilitate operational performance; - Consider everyone as expert in its own domain of influence; - Constant and inclusive communication: maintaining transparency on all aspects and steps both in contents and organization and applying non-violent communication and active listening; - Provide space for reflection on roles and functions and for open discussion on needs and misunderstandings; - Appreciate team work as constantly evolving process of interaction and learning. Results We built a strong resilient team and could leverage team diversity to deliver on project objectives with exceptional quality, adaptability in a highly complex and frequently changing implementation setting. Lessons Working across cultures, disciplines, professions and countries means to develop a joint communication language and an understanding of the other. It is challenging and dynamic, requires additional space/time and attention, but offers personal growth and self-realization. Key messages • Using a participatory approach in teams can leverage team diversity to deliver on project objectives and bring about a high professional and personal self-realization. • There are concrete implementable ways of teamwork in international interdisciplinary global health collaborations that enhance quality of results in complex implementation settings.

How Do Socially Responsible Investment Funds Go Green? The Influence of Investment Styles and managers' Experience

ABSTRACTWe provide an holdings‐based analysis of socially responsible investment (SRI hereafter) funds' greenness and its determinants in Europe over 8 years (2015–22). To this end, a segmentation of SRI funds by greenness degree based on k‐means clustering is developed. Our results reveal that SRI funds' greenness depends on specific investment styles and the salient experience of managers in SRI. We verify that greening an SRI fund implies a higher stock selectivity leading managers to underweight their portfolios with fossil fuel stocks and raise the weight of green stocks once SRI market regulations in Europe have been implemented. Also, we find that active investment styles make SRI funds greener. Moreover, we provide evidence of counteracting experience effects provided that the more (resp. less) the manager is experienced in SRI (resp. mutual fund industry), the greener the fund is. In addition to those experience effects, we detect a gender diversity effect provided that a greater gender diversity in fund management teams contributes to increase SRI funds' greenness. Overall, our findings support the argument that the experience and abilities of fund managers are important factors for investors to consider when they choose SRI funds notably because skilled professionals with more experience in SRI are more likely to adapt to regulatory shifts.

Understanding the relationship between team diversity and the innovative performance in research teams using decision tree algorithms: evidence from artificial intelligence

Understanding the relationship between team diversity and the innovative performance in research teams using decision tree algorithms: evidence from artificial intelligence

Enhancing Equity in Clinical Research: A Multifaceted Proposal for Spondyloarthritis.

Clinical research advances medical knowledge and improves healthcare outcomes. However, disparities in research participation hinder progress. The Unmet Research Needs in Spondyloarthritis Conference IV highlighted critical insights and strategies to enhance equity in clinical research. Talks focused on engaging underrepresented communities and addressing disparities in rheumatic diseases, particularly spondyloarthritis (SpA), to ensure research results are generalizable and inclusive. Disparities in SpA management, such as greater back pain severity among Black and Hispanic Americans and sex-based differences in pain management, emphasize the need for equitable research. Dr. Elizabeth Ferucci discussed the racial disparities in rheumatologic care, highlighting the importance of early access to rheumatologists and culturally informed primary care to improve outcomes. Dr. Hani El-Gabalawy's talk on engaging Indigenous communities stressed the importance of community consent and reciprocal benefits. Dr. Sarfaraz Hasni's presentation on mitigating disparities in research participation underscored the need for inclusive practices and strategies to promote diverse representation. Finally, Dr. Edith Williams emphasized institutional approaches to fostering equity, including diverse recruitment practices and institutional review board alignment with diversity priorities. Strategies to enhance equity in clinical research include community engagement, addressing logistical barriers to participation, and ensuring diverse research teams. These approaches can dismantle barriers for underrepresented communities, making research more accessible and reflective of the broader population. The SpA research community must commit to creating structures that foster inclusivity, ensuring medical advancements benefit all populations, especially historically underrepresented groups. The principles and strategies proposed serve as a roadmap for achieving equity in SpA research.

Adapting a Telehealth Physical Activity and Diet Intervention to a Co-Designed Website for Self-Management After Stroke: Tutorial

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the “design thinking” framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND – Let’s get moving (physical activity intervention) and i-REBOUND – Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND – Let’s get moving and i-REBOUND – Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.

Structuring and empirical validation of a creative activity chain model for innovation in sustainable infrastructure development

This study constructs and empirically validates a Creative Activity Chain (CCA) structure model tailored for innovation in sustainable infrastructure development. In today’s competitive environment, fostering innovation is crucial for maintaining the relevance and effectiveness of infrastructure projects. The research underscores that a significant portion of a project’s long-term value is established during its initial concept and planning stages, highlighting the critical role of creativity in infrastructure development. The CCA model is developed through theoretical frameworks and empirical data, encompassing three key dimensions: creative subject chain, creative action chain, and creative operation chain. The model’s validity is tested with data from five large infrastructure development firms in China, involving 768 R&D staff as respondents. Rigorous statistical methods, including exploratory factor analysis (EFA), confirmatory factor analysis (CFA), structural equation modeling (SEM), and regression analysis, confirm the model’s robustness. The findings reveal significant positive correlations between the creative activity chain’s dimensions and the successful development of sustainable infrastructure projects. Additionally, the study examines the mediating effect of link strength within the creative activity chain, demonstrating its substantial impact on project outcomes. Implications for management include promoting diverse creative teams, systematic process management, and leveraging varied operational tools to enhance creativity in infrastructure development. This research contributes to the literature by introducing an integrated model for managing creative activities in sustainable infrastructure development, offering practical insights for improving innovation processes.

Trainees as teachers: Building evaluative judgement through peer teaching.

While peer teaching is often seen as benefiting learners, it can also benefit peer teachers. One possible mechanism is by building peer teachers' evaluative judgement or their ability to judge the quality of work of selves and others. This qualitative interview study explores how specialty medical trainees build evaluative judgement through peer teaching. It also acts as an illustrative example of researcher positionality within a special series exploring facets of qualitative methodologies. Seventeen interviews with specialty trainees were recorded and thematically analysed, using qualitative description to stay close to the trainees' views of their experiences. We reflect on our positionality throughout. Two thematic categories are interpreted: (1) Peer teaching as uni-directional. (2) Reflecting on one's own practice through peer teaching develops evaluative judgement. Findings suggest the significance of self-scrutiny in response to teaching dialogues, learner cues or fixing problems, in order to develop evaluative judgement. With respect to positionality, reflection suggests the value of diverse teams, and the need for reflexivity due to the sensitising nature of expertise.

Framework for Nursing Quality Assessment in Tracheotomy Dysphagia Following Craniocerebral Trauma Using the Structure-Process-Outcome Model.

This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the 'structure-process-outcome' model. A Delphi survey. The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts. The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90-5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators. The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes. This study develops targeted NSQIs to improve dysphagia management in ABI patients' posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training. Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.

Reflecting on vulnerability, skill-building, and identity in an interdisciplinary SaP project

Launched in 2021 by a team of undergraduate students, university faculty, associate researchers, and community partners collaborating as genuine equals in a diverse team, the Together Time Story Sacks intergenerational literacies program forms part of an ongoing action research project aimed at understanding and addressing barriers that residents of rural regions face in accessing literacies programming. In this paper, six team members who co-imagined, co-designed and co-implemented Together Time but occupy different roles on and beyond university campuses reflect on the ways the students-as-partners (SaP) model, through which we brought Together Time to life, shaped both our process and our outputs during the project’s pilot phase (September 2021–August 2022). We suggest that empowering humans with diverse academic and lived experiences through the SaP model is an Invigorating, messy, and, at times, nerve-racking process but an eminently fruitful enterprise that, in our opinion, produces rich research with and for our community while transforming our understanding of education and ourselves.

Gender diversity in top management teams and corporate reputation: Evidence from Spanish listed companies

AbstractCompanies gain significant advantages from having a favorable corporate reputation (CR), so researchers have analyzed the factors that contribute to the formation and maintenance of this intangible asset. One of these variables could be gender diversity in management. This study drew on stakeholder, signaling, and critical mass theories to explore how women in firms' top management teams (TMTs) can influence these organizations' CR. A sample of data on Spanish listed companies were collected for the period of 2017–2022. The results reveal that a positive relationship exists between gender diversity in TMTs and CR and that this relationship is moderated by women on boards of directors and by board independence. The findings contribute to the literature by providing evidence of top management's influence on CR. This empirical research also expands the literature on gender diversity in organizations by demonstrating that the positive impact of gender diversity on CR extends beyond boards of directors.

The Potential of Disease Progression Modeling to Advance Clinical Development and Decision Making.

While some model-informed drug development frameworks are well recognized as enabling clinical trials, the value of disease progression modeling (DPM) in impacting medical product development has yet to be fully realized. The Clinical Trials Transformation Initiative assembled a diverse project team from across the patient, academic, regulatory, and industry sectors of practice to advance the use of DPM for decision making in clinical trials and medical product development. This team conducted a scoping review to explore current applications of DPM and convened a multi-stakeholder expert meeting to discuss its value in medical product development. In this article, we present the scoping review and expert meeting output and propose key questions that medical product developers and regulators may use to inform clinical development strategy, appreciate the therapeutic context and endpoint selection, and optimize trial design with disease progression models. By expanding awareness of the unique value of DPM, this article does not aim to be technical in nature but rather aims to highlight the potential of DPM to improve the quality and efficiency of medical product development.

Understanding Leadership from the Inside: Using Ethnographic Methods to Examine How the Interplay between Leaders, Followers, and Group Context Shapes Leadership Outcomes.

This paper outlines a novel method for leadership researchers and practitioners to understand how and why effective and ineffective leadership look different in different groups. Leadership is a complex and contextually dependent process influenced by the interplay between leaders, followers, the group, and their environment. The social identity approach to leadership describes how a group's identity shapes the ways in which people can lead effectively. It also implies that (in)effective leadership looks different across diverse groups and teams. Accordingly, it follows that there is no single correct way to lead. To explore these ideas, we propose ethnographic methods, where researchers and practitioners immerse themselves in a group environment, as a novel type of method for examining leadership in action. We suggest the social identity approach as a framework to help guide researchers' data collection and sense-making of leadership behaviours. Additionally, we explain that ethnographic data can be represented well through creative non-fiction stories that capture the context surrounding leadership behaviours. These stories could support leadership consultancy and development programs to demonstrate the complex interplay between leaders, followers, and the group context.

Revolutionizing cancer treatment: an in-depth exploration of CAR-T cell therapies.

Cancer is a leading cause of fatality worldwide. Due to the heterogeneity of cancer cells the effectiveness of various conventional cancer treatment techniques is constrained. Thus, researchers are diligently investigating therapeutic approaches like immunotherapy for effective tumor managements. Immunotherapy harnesses the inherent potential of patient's immune system to achieve desired outcomes. Within the realm of immunotherapy, CAR-T (Chimeric Antigen Receptor T) cells, emerges as a revolutionary innovation for cancer therapy. The process of CAR-T cell therapy entails extracting the patient's T cells, altering them with customized receptors designed to specifically recognize and eradicate the tumor cells, and then reinfusing the altered cells into the patient's body. Although there has been significant progress with CAR-T cell therapy in certain cases of specific B-cell leukemia and lymphoma, its effectiveness is hindered in hematological and solid tumors due to the challenges such as severe toxicities, restricted tumor infiltration, cytokine release syndrome and antigen escape. Overcoming these obstacles requires innovative approaches to design more effective CAR-T cells, which require a competent and diverse team to develop and implement. This comprehensive review addresses numerous therapeutic issues and provides a strategic solution while providing a deep understanding of the structural intricacies and production processes of CAR-T cells. In addition, this review explores the practical aspects of CAR-T cell therapy in clinical settings.

"This has reinvigorated me": perceived impacts of an innovation training program on employee experience and innovation support.

Innovation is widely desired within healthcare organizations, yet the efficacy of programs aimed at fostering it remain largely unassessed, with little consideration given to their effects on employee experience. The Veterans Health Administration (VA) innovators network (iNET) was established to provide organizational support to improve and reimagine patient care and processes across the VA. We evaluated participant perspectives on how iNET impacted workplace experience and fostered innovation. Semi-structured interviews were conducted using purposive sampling to maximize diversity for program roles and site characteristics, reviewed using a rapid matrixed approach, then analyzed using a hybrid inductive/deductive approach that applied a theoretical framework of innovation supportive domains. 21 project investees, 16 innovation specialists and 13 leadership champions participated from 15 sites nationally. Most participants reported strongly positive impacts including feeling re-energized, appreciating new experiences and expanded opportunities for connecting with others, sense of renewed purpose, better relationships with leadership and personal recognition. Negative experiences included time constraints and logistical challenges. Participants' experiences mapped frequently onto theorized domains of supporting a curious culture, creating idea pathways and porous boundaries, fostering/supporting catalytic leadership and supporting (role) diverse teams. The program's delivery of ready resources was critically supportive though at times frustrating. Participants' experiences support the conclusion that iNET fosters innovation and positively impacts participating employees. In the post-pandemic context of unprecedented challenges of healthcare worker burnout and stress, effective innovation training programs should be considered as a tool to improve worker experience and retention as well as patient care.

Artificial Intelligence &amp; the Capacity for Discrimination: The Imperative Need for Frameworks, Diverse Teams &amp; Human Accountability

The increasing integration of Artificial Intelligence (AI) in various industries has led to concerns about how these systems can perpetuate discrimination, particularly in fields like employment, healthcare, and public policy. Multiple academic and business perspectives on AI discrimination, focusing on the need for global policy coordination and ethical oversight to mitigate biased outcomes, ask for our technical innovators to create contingencies that will better protect humanity’s experience with AI’s ever-expanding reach. Central to the key constructs such as biased datasets, algorithmic transparency, and the global governance of AI systems can function as a harmful drawback to these systems. Without adequate data governance and transparency, AI systems can perpetuate discrimination. AI's ability to discriminate stems primarily from biased data and the opacity of machine learning models, necessitating proactive research and policy implementation on a global scale. These frameworks must transcend the limitations of the experiences or perspectives of their programmers to ensure that AI innovations are ethically sound and that their use in global organizations adheres to principles of fairness and accountability. This synthesis will explore how these articles advocate for comprehensive, continuous monitoring of AI systems and policies that address both local and international concerns, offering a roadmap for organizations to innovate responsibly while mitigating the risks of AI-driven discrimination.

The Manifestation and Implications of Bias in Artificial Intelligence on Global Society

Although artificial intelligence (AI) is becoming more and more prevalent, biases from data, algorithms, and feedback loops might still exist. Marginalized groups may be disproportionately affected by these biases, which may result in biased outcomes in areas such as facial recognition, credit scoring, and hiring. Reduced trust, sustained societal inequality, and stifled innovation are some of the effects. It is critical to support transparent development processes, diverse development teams, and ethical oversight in AI design in order to lessen these effects. If these issues are resolved, AI will become a more equitable instrument for advancing society.

Identifying and addressing health-related social needs: a Medicaid member perspective.

Multiple state and national health care organizations have invested in activities to screen for and address the health-related social needs (HRSNs) of their patients. However, patient perspectives concerning HRSN screening discussions and facilitated referrals to supports are largely unexplored. The main objectives of this study were to explore the ways in which Massachusetts Medicaid (MassHealth) members engage with their health care clinicians to discuss HRSNs, to identify common needs discussed, and to describe whether members feel these needs are being addressed by health care clinicians and staff. The study team performed a cross-sectional, qualitative research study that included in-depth, open-ended interviews with 44 adult MassHealth members. Interviews were conducted between June and October 2022. Interviews were recorded, transcribed, and systematically coded for analysis, and common themes were reported. The data collected for this study were part of a larger independent evaluation of MassHealth's 2017-2022 Section 1115 Demonstration that granted authority from CMS to implement health care delivery system reforms in Massachusetts. In this qualitative study of Medicaid members, some reportedly felt comfortable freely discussing all of their clinical and social needs with their health care clinicians, while others noted feelings of apprehension. Several members recalled being asked about their HRSNs in various clinical or community settings, while others did not. The majority of members endorsed having an unmet HRSN, including housing, nutrition, financial, or transportation issues, and many barriers to addressing these HRSNs were discussed. Finally, many members cited a preference for discussing HRSNs with community-based care coordinators and social workers at the community partner organizations rather than with their health care clinicians. Community-based care coordinators were lauded as essential facilitators in making the connection to necessary resources to help address HRSNs. Study results highlight an opportunity to increase the effectiveness of HRSN screening and referral practices within the health care setting through relationship building between Medicaid members and diverse interdisciplinary care teams that include staff such as community health workers. Continued investment in cross-sector partnerships, screening workflows, and patient-clinician relationships may contribute to establishing an environment in which members can comfortably discuss HRSNs and connect with needed services to improve their health.

8469 Endocrinologists Underutilize Virtual Care Services Resulting in Suboptimal Clinical and Financial Outcomes

Abstract Disclosure: D. Terry: Employee; Self; Valendo Health. Less than 150,000 Medicare patients with diabetes (PWD) receive billable telehealth and remote monitoring services, even though over 12 million PWDs are eligible for these services. This is a missed quality opportunity, as studies show that PWDs who receive these services experience reductions in A1C levels and improvements in TIR. It is also a missed financial opportunity for Endocrinologists, who are among the lowest paid specialists in the US. The economics of Endocrinology are important, because inadequate compensation is leading to access constraints when the diabetes population is growing, and care complexity is increasing. We analyzed billed virtual health claims for every Medicare PWD in 2022. The types of services we examined included: Chronic Care Management (CCM &amp; PCM), Continuous Glucose Monitoring (CGM &amp; RPM), Medical Nutrition Therapy (MNT), and Diabetes Self-Management Training (DSMT). When we looked by Endocrinologist by virtual care service type, we found the following levels of service delivery for Endocrinologists at the median levels of utilization:4.8% of eligible PWDs received remote Continuous Glucose Monitoring support.4.2% received virtual Chronic Care Management services.6.2% received virtual Diabetes Self-Management Support.&amp;lt;1% received Medical Nutrition Therapy This is clearly a missed clinical quality opportunity as a study published in JAMA in October 2023, Comprehensive Telehealth Model to Support Diabetes Self-Management, reported the following improvements for PWDs who received virtual care for 6 months:Mean change in A1C levels: Type 1: -0.6%; Type 2: -1.0%Mean TIR Improvement: Type 1: 16%; Type 2: 18% It is also a missed financial opportunity for Endocrinology practices. Each patient with diabetes is potentially eligible for $100 or more of virtual care services per month. We’ve looked at every Endocrinology practice in the US and many are missing out on over a million dollars of annual revenue opportunity. This is important as Endocrinology organizations everywhere, independent and hospital based, are struggling to retain the doctors &amp; staff necessary to provide adequate access to care - leading to months of wait time to see an Endocrinologist. The prevalence of diabetes is growing significantly, while Endocrinologist capacity is shrinking. Value added and billable virtual care services create new opportunities for Endocrinologist to generate the revenue necessary to increase clinical capacity and improve access by creating diverse clinical teams led by Endocrinologists and supported by Diabetes Educators, Dietitians, and others with expertise in diabetes who can care for many more PWDs. Creating virtual care capabilities is also an early step in moving Endocrinology into Value-Based Care arrangements that reward providers for improving care and reducing costs rather than for generating more visits. Presentation: 6/1/2024