Shared Medical Research Articles

Multiple Sclerosis Wellness Shared Medical Appointment Model: A Pilot Study.

Shared medical appointments (SMAs) are group medical visits combining medical care and patient education. We examined the impact of a wellness-focused pilot SMA in a large multiple sclerosis (MS) clinic. We reviewed data on all patients who participated in the SMA from January 2016 through June 2019. The following data were collected 12 months pre/post SMA visits: demographics, body mass index, patient-reported outcomes, and health care utilization. Data were compared using the Wilcoxon rank sum test. Fifty adult patients (mean ± SD age, 50.1 ± 12.3 years) attended at least one MS wellness SMA. Most patients had private insurance (50%), and 26% had Medicaid coverage. The most common comorbidity was depression/anxiety (44%). Pre/post SMA outcomes showed a small but significant reduction in body mass index (30.2 ± 7.3 vs 28.8 ± 7.1, P = .03), and Patient Health Questionnaire-9 scores decreased from 7.3 ± 5.5 to 5.1 ± 5.6 (P = .001). The number of emergency department visits decreased from 13 to two (P = .0005), whereas follow-up visits increased with an attendees' primary care provider from 19 to 41 (P < .001), physical therapist from 15 to 27 (P = .004), and psychologist from six to 19 (P = .003). This pilot MS wellness SMA was associated with improved physical and psychological outcomes. There was increased, lower-cost health care utilization with reduced acute, high-cost health care utilization, suggesting that SMAs may be a cost-effective and beneficial method in caring for patients with MS.

Optimizing Care Delivery by Applying an Innovative Shared Medical Appointment Model for Determination of Cochlear Implant Candidacy.

To develop and implement an innovative group appointment with the potential to improve access to cochlear implantation (CI) while maintaining patient satisfaction and experience. Adult patients with advanced sensorineural hearing loss. Implementation of novel shared medical appointment (SMA) model. Patient satisfaction with group visit; anecdotal description of provider efficiency and experience. Survey data were collected from 166 adults who participated in a group CI candidacy appointment from September 2017 to February 2020 as part of a quality improvement initiative. Provider time is anecdotally optimized by accommodating more patients in a shorter timeframe while effectively triaging those candidates most likely to meet candidacy criteria for a full CI evaluation. Most importantly, patient feedback has been positive which suggests that patients find value in this novel format. The current climate of healthcare demands that providers maximize the efficacy and efficiency of patient care. Our large CI program has determined that using an SMA format as an entry point for CI candidacy evaluation offers many benefits. The group appointment improves patient throughput and also provides a positive patient experience. Group visits offer a viable solution for increasing patient access to CI while maintaining quality in a busy academic medical center setting.

QIM21-081: Shared Medical Appointments for Cancer Survivors: A Feist Weiller Cancer Center Pilot Study

QIM21-081: Shared Medical Appointments for Cancer Survivors: A Feist Weiller Cancer Center Pilot Study

Patient and Clinician Satisfaction With Shared Medical Appointments for Glaucoma

ABSTRACT Shared Medical Appointments (SMAs) are patient-centered care tools designed to administer patient counseling and education, typically delivered individually, in a group setting. SMAs are effective in facilitating peer-learning, resulting in improvement in knowledge and health behavior. This study aimed to implement what we know of as the first ophthalmology SMA done in the United States. We evaluated the implementation feasibility, patient and provider experience, changes in patient knowledge, and provider stress. Five glaucoma patients who expressed issues with adherence during their clinic visit at Boston Medical Center (BMC) who were interested in the SMA were recruited. Patients and staff had a positive experience with the SMA. There was a marked increase in patient glaucoma knowledge and a decrease in average staff member stress level score during the SMA. From all standpoints, including billing and management, we conclude that SMA implementation is feasible in ophthalmology departments in academic settings.

“Living Well with Chronic Pain”: Integrative Pain Management via Shared Medical Appointments

ObjectiveTo evaluate the effectiveness of a multidisciplinary, nonpharmacological, integrative approach that uses shared medical appointments to improve health-related quality of life and reduce opioid medication use in patients with chronic pain.DesignThis is a retrospective, pre–post review of “Living Well with Chronic Pain” shared medical appointments (August 2016 through May 2018).SettingThe appointments included eight 3-hour-long visits held once per week at an outpatient wellness facility.SubjectsPatients with chronic, non–cancer-related pain.MethodsPatients received evaluation and evidence-based therapies from a team of integrative and lifestyle medicine professionals, as well as education about nonpharmacological therapeutic approaches, the etiology of pain, and the relationship of pain to lifestyle factors. Experiential elements focused on the relaxation techniques of meditation, yoga, breathing, and hypnotherapy, while patients also received acupuncture, acupressure, massage, cognitive behavioral therapy, and chiropractic education. Patients self-reported data via the Patient-Reported Outcomes Measurement Information System (PROMIS-57) standardized questionnaire. Use of opioid medications was evaluated in morphine milligram equivalents.ResultsA total of 178 participants completed the PROMIS-57 questionnaire at the first and the last visits. Statistically significant improvements in all domains (Physical Functioning, Anxiety, Depression, Fatigue, Social Roles, Pain Interference, and Sleep Disturbance) were observed (P < 0.001) between the pre-intervention (visit 1) and post-intervention (visit 8) scores. Average opioid use decreased nonsignificantly over the 8-week intervention, but the lower rate of opioid use was not sustained at 6 and 12 months’ follow-up.ConclusionsPatients suffering from chronic pain who participated in a multidisciplinary, nonpharmacological treatment approach delivered via shared medical appointments experienced reduced pain and improved measures of physical, mental, and social health without increased use of opioid pain medications.

Evaluating the Effectiveness of Diabetes Shared Medical Appointments (SMAs) as Implemented in Five Veterans Affairs Health Systems: a Multi-site Cluster Randomized Pragmatic Trial

ObjectiveTo examine whether diabetes shared medical appointments (SMAs) implemented as part of usual clinical practice in diverse health systems are more effective than usual care in improving and sustaining A1c improvements.Research Design and MethodsA multi-site cluster randomized pragmatic trial examining implementation in clinical practice of diabetes SMAs in five Veterans Affairs (VA) health systems was conducted from 2016 to 2020 among 1537 adults with type 2 diabetes and elevated A1cs. Eligible patients were randomly assigned to either: (1) invitation to participate in a series of SMAs totaling 8–9 h; or (2) continuation of usual care. Relative change in A1c (primary outcome) and in systolic blood pressure, insulin starts, statin starts, and anti-hypertensive medication classes (secondary outcomes) were measured as part of usual clinical care at baseline, at 6 months and at 12 months (~7 months after conclusion of the final SMA in four of five sites). We examined outcomes in three samples of SMA participants: all those scheduled for a SMA, those attending at least one SMA, and those attending at least half of SMAs.ResultsBaseline mean A1c was 9.0%. Participants scheduled for an SMA achieved A1c reductions 0.35% points greater than the control group between baseline and 6-months follow up (p = .001). Those who attended at least one SMA achieved reductions 0.42 % points greater (p < .001), and those who attended at least half of scheduled SMAs achieved reductions 0.53 % points greater (p < .001) than the control group. At 12-month follow-up, the three SMA analysis samples achieved reductions from baseline ranging from 0.16 % points (p = 0.12) to 0.29 % points (p = .06) greater than the control group.ConclusionsDiabetes SMAs as implemented in real-life diverse clinical practices improve glycemic control more than usual care immediately after the SMAs, but relative gains are not maintained. Our findings suggest the need for further study of whether a longer term SMA model or other follow-up strategies would sustain relative clinical improvements associated with this intervention.Trial RegistrationClinicalTrials.gov ID NCT02132676

Improved Lightweight Cloud Storage Auditing Protocol for Shared Medical Data

Now, it is common for patients and medical institutions to outsource their data to cloud storage. This can greatly reduce the burden of medical information management and storage and improve the efficiency of the entire medical industry. In some cases, the group‐based cloud storage system is also very common to be used. For example, in an medical enterprise, the employees outsource the working documents to the cloud storage and share them to the colleagues. However, when the working documents are outsourced to the cloud servers, how to ensure their security is a challenge problem for they are not controlled physically by the data owners. In particular, the integrity of the outsourced data should be guaranteed. And the secure cloud auditing protocol is designed to solve this issue. Recently, a lightweight secure auditing scheme for shared data in cloud storage is proposed. Unfortunately, we find this proposal not secure in this paper. It’s easy for the cloud server to forge the authentication label, and thus they can delete all the outsourced data when the cloud server still provide a correct data possession proof, which invalidates the security of the cloud audit protocol. On the basis of the original security auditing protocol, we provide an improved one for the shared data, roughly analysis its security, and the results show our new protocol is secure.

Effects of Shared Medical Appointments Compared With Individual Appointments in Children With Atopic Dermatitis: A Pragmatic Randomized Controlled Trial

WT Zijlstra, H van Os-Medendorp, KB Fieten. Clin Exp Allergy . 2019;49(8):1095–1106 To evaluate the effects of shared medical appointments (SMA) compared with individual appointments (IA) for children with atopic dermatitis and their parents. Parental emotional coping, quality of life, anxiety about topical steroid treatment and patient disease activity were assessed through questionnaires. SMA or group visits were conducted with clinicians seeing multiple patients simultaneously, combining individualized patient care with peer support and self-management education. This format has been successfully used for children and their families with other chronic health conditions such as diabetes and hemophilia. Children younger than 18 years who were diagnosed with atopic dermatitis and were being seen …

Shared Medical Appointments and Mindfulness for Type 2 Diabetes-A Mixed-Methods Feasibility Study.

IntroductionType 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia.Materials and MethodsWe conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, self-reported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer.ResultsOver a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; p = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; p = 0.034).ConclusionpSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted.Clinical Trial RegistrationAustralia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112.

Reducing Heart Failure Readmissions Through a Shared Medical Appointment

IntroductionIn March 2018, the Orlando Veterans Affairs Healthcare System (OVAHCS) heart failure (HF) readmission rate was 30.4%, notably higher than the national rate of 17.3%. The HF Team manages NYHA III and IV patients (1,000 of 3,500 at OVAHCS) and was unable to see patients within 14 days of hospital discharge. Many patients were being discharged with a limited supply (7 days) of newly adjusted medications resulting in an inadequate supply to last until the patient's post-discharge follow-up appointment.GoalsImprove clinic access and develop a multidisciplinary treatment approach by providing focused education, linking high risk patients with beneficial resources, reducing patients lost to follow-up, ensuring timely medical support to improve HF self-management and reducing admissions.MethodsThe HF Program implemented the use of a Shared Medical Appointment (SMA) to target these high-risk patients, focusing on non-adherent, frequently admitted or those at risk for future admissions. The SMA was offered every 2 weeks allowing patients to be seen within 14 days of discharge. The SMA included comprehensive care that targeted education, behavioral change, and medical intervention (e.g., exam, medication changes, refills). Consults to supportive services (e.g., clinical pharmacist, clinical psychologist, dietician, telehealth, educational classes) were offered. The SMA visit also aligned with Cardiology Clinic IV diuresis appointment slots in effort to avoid preventable admissions.ResultsFrom August 2018 to April 2019, all patients targeted for the SMA were offered an appointment within 14 days of discharge. Only 8% of those seen in SMA were readmitted compared to 28% of those seen in a traditional HF team follow-up appointment. Through the SMA, an average of 2.5 consults per Veteran were placed to facilitate improved HF management. Additionally, 97% of patients required medication alterations to avoid re-hospitalization, 50% required equipment to self-monitor symptoms, 78% were referred to a Cardiology PharmD for medication optimization, 41% engaged in treatment with a clinical health psychologist to focus on health behavior, and 36% joined HF Education Classes for additional learning opportunities beyond SMA.ConclusionsParticipating in the HF SMA greatly reduced the likelihood of being re-admitted within 31 days when compared to traditional Cardiology HF visits. The group setting and brief exam aspect of the SMA improves efficiency by providing care to more Veterans at once than would be possible if done individually. Patients seen through the SMA were able to be seen within 14 days of hospital discharge. Including more providers and offering SMAs more frequently may help reduce re-admission rates to a greater number of patients.

Adapting Diabetes Shared Medical Appointments to Fit Context for Practice-Based Research (PBR).

Complex behavioral interventions such as diabetes shared medical appointments (SMAs) should be tested in pragmatic trials. Partnerships between dissemination and implementation scientists and practice-based research networks can support adaptation and implementation to ensure such interventions fit the context. This article describes adaptations to and implementation of the Targeted Training in Illness Management (TTIM) intervention to fit the primary care diabetes context. The Invested in Diabetes pragmatic trial engaged 22 practice-based research network practices to compare 2 models of diabetes SMAs, based on TTIM. We used surveys, interviews, and observation to assess practice contextual factors, such as practice size, location, payer mix, change and work culture, motivation to participate, and clinical and administrative capacity. The enhanced Replicating Effective Programs framework was used to guide adaptations to TTIM and implementation in participating practices. Practices varied in size and patient demographics. All practices had integrated behavioral health, but limited health educators or prescribing providers. Adaptations to SMA delivery accommodated the need for flexibility in personnel and reduced scheduling burden. Adaptations to TTIM content were designed to fit general primary care diabetes and Spanish-speaking patients. Enhanced Replicating Effective Programs is a useful process framework for adaptation, implementation, and testing of diabetes SMAs in primary care. Adapting intervention content, delivery, and training to fit context can help ensure pragmatic trials have both internal and external validity. Attention to intervention fit to context can support continued practice engagement in research and sustainability of evidence-based interventions.

Lifestyle Medicine Shared Medical Appointments.

Chronic diseases pose many challenges to health care providers and the health care system from a human capital, logistic, and financial perspective. To overcome these challenges, efficient and effective health care delivery models that address multiple chronic conditions need to be leveraged. Shared medical appointments are one potential solution to address these issues. This article offers a brief history of group visits and shared medical appointments and reviews the available data regarding their outcomes. It describes the benefits of using lifestyle medicine as the primary therapeutic modality within a shared medical appointment to treat, reverse, and prevent chronic disease. Key considerations and action steps for the implementation of lifestyle medicine shared medical appointments (LMSMAs) are outlined and the potential delivery of these services via telehealth is explored.

A Cloud-Ready Architecture for Shared Medical Imaging Repository.

Nowadays usage paradigms of medical imaging resources are requesting vendor-neutral archives, accessible through standard interfaces, with multi-repository support. Regional repositories shared by distinct institutions, tele-radiology as a service at cloud, teaching, and research archives are illustrative examples of this new reality. However, traditional production environments have a server archive instance per functional domain where every registered client application has access to all studies. This paper proposes an innovator ownership concept and access control mechanisms that provide a multi-repository environment and integrates well with standard protocols. A secure accounting mechanism for medical imaging repositories was designed and instantiated as an extension of a well-known open-source archive. A new web service layer was implemented to provide a vendor-neutral solution compliant with modern DICOM Web protocols for storage, search, and retrieval of medical imaging data. The concept validation was done through the integration of proposed architecture in an open-source solution. A quantitative assessment was performed for evaluating the impact of the mechanism in the usual DICOM Web operations. This article proposes a secure accounting architecture able to easily convert a standard medical imaging archive server in a multi-repository solution. The proposal validation was done through a set of tests that demonstrated its robustness and usage feasibility in a production environment. The proposed system offers new services, fundamental in a new era of cloud-based operations, with acceptable temporal costs.

Can Shared Service Delivery Increase Customer Engagement? A Study of Shared Medical Appointments

Problem Definition: Customers and providers alike often consider one-on-one service delivery to be ideal, assuming – perhaps unquestioningly – that devoting individualized attention maximizes customer engagement and improves outcomes. Alternatively, shared service delivery, in which customers are served in batch, may – through the dynamics of group interaction – lead to increased customer engagement. However, the loss of privacy and personal connection in shared delivery models may undermine engagement, and consequently, outcomes. Academic / Practical Relevance: The engagement dynamics in one-on-one and shared delivery models have not been rigorously studied. To the extent that shared delivery may result in comparable or better engagement than one-on-one delivery, service providers in a broad array of contexts may be able to create more value for customers by delivering service in batches. Methodology: We conducted a randomized con- trolled trial with 1,000 patients who were undergoing glaucoma treatment over a three-year period at a large eye hospital. Using verbatim and behavioral transcripts from over 20,000 minutes of video recorded during our trial, we examine how shared medical appointments (SMAs) – in which groups of patients with similar conditions meet with a doctor simultaneously, and each receives one-on-one care in turn – impact patients’ engagement during their appointments. Results: Patients who experienced SMAs asked 37.2% more questions per minute, made 8.2% more comments per minute, answered 3.6% more questions per minute, and exhibited higher levels of non-verbal engagement across a wide array of measures (attentiveness, positivity, head wobbling or ‘talai taḷḷāṭṭam in Tamil – a South Indian gesture to signal agreement or understanding – eye contact and end-of-appointment happiness), relative to patients who attended one-on-one appointments. Managerial Implications: These results shed light on the potential for shared service delivery models to increase customer engagement and enhance service performance.

642-P: Identifying Value Propositions to Engage Patients with Type 2 Diabetes in Shared Medical Appointments

Objective: Type 2 diabetes (T2D) affects 12% of U.S. adults and is a major public health burden. Shared medical appointments (SMAs) are an effective strategy to deliver diabetes self-management education and support (DSMES) alongside medical care, yet recruitment is a common challenge. Enhanced communication strategies have been recommended, while identifying specific messaging to engage patients with T2D remains needed. Methods: The Invested in Diabetes project is a cluster-randomized, pragmatic comparative effectiveness trial of two models of SMAs using an evidence-based DSMES curriculum. To aid recruitment at 22 primary care clinics, a group of patient, practice and research stakeholders used value proposition design strategies to develop tailored messaging on how SMAs can reduce pains and yield gains related to T2D. Patient stakeholders further refined messages to ensure patient-driven language. Here we describe value propositions for patients with newly diagnosed or uncontrolled T2D, diabetes distress, and comorbid conditions, plus concerned others. Results: General messaging emphasized how SMAs may help patients with T2D through expert education, addressing concerns, behavior change strategies, problem-solving, stress-coping skills, normalizing, and peer support. Messaging emphasized respect for autonomy (“you are your best health advocate”) coupled with available support (“you don’t have to go it alone”). For uncontrolled T2D, messages further conveyed opportunities to “finally take control” of T2D. For diabetes distress, messages also conveyed how SMAs may reduce feeling overwhelmed by T2D. Concerned others were encouraged to show support by telling patients about diabetes SMAs. Conclusions: Value proposition themes include how diabetes SMAs can improve T2D control and related stress, which may aid patient engagement. For clinics offering diabetes SMAs, messaging can be delivered by care team members and integrated into various recruitment activities. Disclosure N.D. Ritchie: None. A. Begum: None. J. Dailey-Vail: None. J. Rementer: None. R.A. Koren: None. S.A. Trujillo: None. P. Phimphasone-Brady: None. K.A. Cassidy: None. R. Wearner: None. J. Waxmonsky: None. B. Kwan: None. Funding Patient-Centered Outcomes Research Institute (IHS-1609-36322)

337-OR: Continuous Glucose Monitoring Shared Medical Appointments Improve A1C and Diabetes Self-Efficacy

Background: Personal continuous glucose monitoring (CGM) is patient owned and often inaccessible due to cost and insurance requirements. Professional CGM is clinic owned, worn for 3-14 days and is an affordable, underutilized option. The present study combined diabetes education and professional CGM into a shared medical appointment (SMA). The SMA allows providers to deliver diabetes education in the setting of medical management and peer support. It was hypothesized that the SMA method of delivering professional CGM would positively impact clinical outcomes (improvements in self-efficacy, A1c and medication doses). Methods: Adults with type 1 and type 2 diabetes who attended the two-part CGM SMA at a large academic medical center were included in this retrospective, single-center study. The CGM SMA included 4-6 patients, diabetes educator and pharmacist. Participants wore professional CGM for 7 days. The primary outcome was change in diabetes self-efficacy through a validated 8-item Likert scale. Secondary objectives were changes in A1c, and changes in diabetes medications (dosage adjustments, time of administration). Paired t-tests were used to analyze change in A1c and diabetes self-efficacy scores. Results: Diabetes self-efficacy scores increased by a mean of 1.63 ± 2.09 points (p&amp;lt;.001) out of 10 points. The A1c decreased by a mean of 0.80 ± 1.52% (p&amp;lt;.001) with a mean follow-up A1C of 7.80 ± 1.60%. Those with baseline A1c ≤8.0% (n=70) experienced a decrease in A1c of 0.24% compared to 1.20% in those with A1c &amp;gt; 8.0% (n=101). Participants utilizing the real time device (n=133) experienced a decrease in A1c by 0.75% compared to 1.0% in those with the blinded device (n=38). Most medication changes made in the CGM SMA were dosage adjustments and changes in administration time. Discussion: The CGM SMA is a novel practice model incorporating diabetes education, peer support, professional CGM, and inter-professional care that demonstrated improvements in diabetes self-efficacy and A1c. Disclosure D. Isaacs: Consultant; Self; Companion Medical, LifeScan, Inc. Speaker’s Bureau; Self; Dexcom, Inc., Novo Nordisk Inc., Xeris Pharmaceuticals, Inc. A. Simonyan: None. J.E. Blanchette: Other Relationship; Self; Tandem Diabetes Care. S. Lekic: None. D. Noe: Consultant; Self; Pyure Organic Stevia. N.R. Galloway: None.

770-P: Behavioral Outcomes of High-Risk Spanish Speaking Latino Patients with Type 1 Diabetes Participating in a Novel Culturally Sensitive Shared Medical Appointment Model

Objective: Spanish speaking (SS), Latino patients (LP) with type 1 diabetes (T1D) face cultural, language and socioeconomic barriers that add to the risk of complications and higher distress. Shared medical appointments (SMAs) are effective models of care to help overcome these barriers. Behavioral outcomes of SS LP with T1D attending a novel culturally sensitive SMA pilot were analyzed. Methods: Patients 1-20 years old and caregivers participated in the SMA pilot program. Pediatric Quality of Life (PedsQL), Diabetes distress (Problem Areas in Diabetes-PAID) surveys and satisfaction scores were obtain baseline and yearly. Higher scores on PedsQL indicate a better overall QoL. Results: Mean A1C at baseline was 9.6% (sd=2.3). Mean distress scores for children and teens decreased from Baseline to Year 2 (47.4 vs. 37.9; p=0.21 and 54.1 vs. 51.8; p=.002, respectively) and showed improvement (not statistically significant) on mean overall QoL. Diabetes specific QoL improved from Baseline to Year 1 (78.4 vs. 81.5, p=0.46 and 68.2 vs. 73.2, p=0.24, respectively). For caregivers from Baseline to Year 2 there was significant increase in distress (39.5 vs. 65.1, p&amp;lt;0.001), had no change in overall QoL, Diabetes specific QoL worsen from Baseline to Year 1 (64.5 vs. 57.9, p=0.04). Children, teens and parents all reported high levels of program satisfaction (means ranged from 41-46/50) with no significant change over time. Conclusions: The novel culturally sensitive SMA model seems an effective strategy to lessen overall distress and increase QoL for High-risk SS LP youth. Parent’s final PAID scores correlated to children’s baseline A1C. It is likely that parent’s data was a result of increased education and awareness of disease seriousness. Sample size was small. Data from continued participation should be further analyzed. Disclosure R. Jensen: None. S. Suttiratana: Employee; Spouse/Partner; CVS Caremark. D. Naranjo: None. A. Gerard Gonzalez: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust (2015PG-T1D060)

1288-P: Novel Culturally Sensitive Shared Medical Appointment Model for High-Risk Latino Youth with Type 1 Diabetes: One-Year Follow-Up Postpilot Intervention

Objective: A novel, culturally sensitive shared medical appointment (SMA) pilot program was evaluated as a continuing model of care for high risk Spanish speaking Latino patients (LP) with type 1 diabetes (T1D). We examined retention and outcomes of participants one year after the pilot research intervention ended. Methods: Changes in outcomes for LP in the SMA from the end of the funded pilot program (year 3) to the first year post-intervention (year 4) were assessed. Retention rates, A1c and diabetes technology uptake (insulin pump and continuous glucose monitor (CGM)) were recorded for children (&amp;lt;12 years) and teens (12+ years). Results: Of the 75 LP enrolled by the end of the funded study period, 64 (85.3%) continued with at least one visit in the SMA in year 4. Average A1c decreased from year 3 to 4, but did not achieve statistical significance (-0.4± 0.3; p=0.128). Teens and children showed a significant increase in insulin pump use in from baseline to Year 4 (Teens: n=35, 26%; p=0.008), (Children: n=12, 75%; p=0.008). Teens and children showed a significant increase in CGM use from baseline to Year 4 (Teens: n=35, 34%; p=0.001) (Children: n=12, 75%; p=0.008). Conclusions: The novel culturally sensitive SMA model demonstrated to be a well-received program for high-risk Spanish speaking LP youth with high retention rates one year after research concluded. Participants continued to demonstrate increase uptake of diabetes technologies. Additional studies of the effects of the SMA on glycemic control are needed. Disclosure R. Jensen: None. K. Campbell: None. L. Pyle: None. A. Gerard Gonzalez: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust (2015PG-T1D060)

Abstract #805290: Endocrinology Shared Medical Appointments: Boosting Revenue, Enhancing Patient Satisfaction: A Pilot From a Community Outpatient Practice

Abstract #805290: Endocrinology Shared Medical Appointments: Boosting Revenue, Enhancing Patient Satisfaction: A Pilot From a Community Outpatient Practice

Multiple Sclerosis Patient’s Health Care Utilization Influenced by MS Wellness Shared Medical Appointments – A Single Center Experience (4202)

Multiple Sclerosis Patient’s Health Care Utilization Influenced by MS Wellness Shared Medical Appointments – A Single Center Experience (4202)