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Of the many innovations in health care delivery proposed in the context of health reform for those with chronic diseases such as diabetes, the group visit model is relatively easy to implement and is effective for improving health outcomes and patient and provider satisfaction, with a neutral to positive effect on health care costs. This article describes the evolution of group visits for those with diabetes, the theory underlying group visits for patients with chronic medical conditions, and the existing evidence for the effectiveness of this model. It also addresses implementation of groups in practice, with an emphasis on the practical aspects of program implementation, integration of behavioral expertise into medical groups, individualization in various practice settings, and reimbursement issues.

Coordinated, multidisciplinary diabetes team care is understood by and acceptable to patients with type 2 diabetes.

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Improving glycemic control across a primary care diabetes population is challenging. This article describes the development, implementation, and outcomes of the Diabetes Care Collaborative Model (DCCM), a collaborative team care process focused on promoting effective insulin use targeting patients with hyperglycemia in a patient-centered medical home model. After a pilot, the DCCM was implemented in 18 primary care practices affiliated with an academic medical center. Its implementation was associated with improvements in glycemic control and increase in insulin prescription longitudinally and across the entire population, with a >1% reduction in the proportion of glycated hemoglobin >9% at 2 years after the implementation compared with the 2 years prior ( P < .001). Facilitating factors included diverse stakeholder engagement, institutional alignment of priorities, awarding various types of credits for participation and implementation to providers, and a strong theoretical foundation using the principles of the collaborative care model.

Background Understanding association between factors related to clinical work environment and well-being can inform strategies to improve physicians’ work experience. Objective To model and quantify what drivers of work composition, team structure, and dynamics are associated with well-being. Design Utilizing social network modeling, this cohort study of physicians in an academic health center examined inbasket messaging data from 2018 to 2019 to identify work composition, team structure, and dynamics features. Indicators from a survey in 2019 were used as dependent variables to identify factors predictive of well-being. Participants EHR data available for 188 physicians and their care teams from 18 primary care practices; survey data available for 163/188 physicians. Main Measures Area under the receiver operating characteristic curve (AUC) of logistic regression models to predict well-being dependent variables was assessed out-of-sample. Key Results The mean AUC of the model for the dependent variables of emotional exhaustion, vigor, and professional fulfillment was, respectively, 0.665 (SD 0.085), 0.700 (SD 0.082), and 0.669 (SD 0.082). Predictors associated with decreased well-being included physician centrality within support team (OR 3.90, 95% CI 1.28–11.97, P=0.01) and share of messages related to scheduling (OR 1.10, 95% CI 1.03–1.17, P=0.003). Predictors associated with increased well-being included higher number of medical assistants within close support team (OR 0.91, 95% CI 0.83–0.99, P=0.05), nurse-centered message writing practices (OR 0.89, 95% CI 0.83–0.95, P=0.001), and share of messages related to ambiguous diagnosis (OR 0.92, 95% CI 0.87–0.98, P=0.01). Conclusions Through integration of EHR data with social network modeling, the analysis highlights new characteristics of care team structure and dynamics that are associated with physician well-being. This quantitative methodology can be utilized to assess in a refined data-driven way the impact of organizational changes to improve well-being through optimizing team dynamics and work composition.

Purpose The purpose of the study was to explore patient perspectives on socioeconomic barriers related to diabetes self-management and interventions to address these barriers. Methods Focus groups (n = 8) were conducted with a diverse sample of adults with type 2 diabetes (T2D; n = 53). Researchers used a semistructured moderator guide; focus groups were audio recorded and transcribed verbatim. Researchers employed the constant comparison method for qualitative content analysis and utilized Atlas.ti (Version 8.1.1) to digitalize the analytic process. Results Findings revealed 3 primary themes: (1) Existing food and nutrition resources are insufficient to support healthy eating for diabetes; (2) healthy eating is critical for diabetes management, but socioeconomic circumstances make doing so challenging; and (3) participants supported several broad categories of preferred intervention strategies. First, they endorsed lifestyle intervention informed by socioeconomic status (SES; eg, focusing on food resource management, sensitive health coaching and nutritional counseling). Next, they expressed enthusiasm for group-based learning opportunities, such as cooking classes and support groups with similar SES peers. Finally, they suggested healthy food access resources. Conclusions Participant suggestions should be incorporated into intervention development. Ultimately, these interventional strategies should be tested and refined to help improve health for individuals with type 2 diabetes.

e24053 Background: Lifestyle medicine emphasizes the role of 6 pillars in preventing chronic disease and improving health: nutrition, physical activity, sleep, stress management, social connection, and avoiding risky substance use. While most oncologists are aware of the role of these factors in reducing risk of recurrence and improving outcomes, there are numerous barriers to addressing these lifestyle factors during clinic visits. The PAVING the Path to Wellness for Breast Cancer Survivors program (PAVING) is a 12-week lifestyle medicine group intervention designed to deliver lifestyle medicine guidelines and practices to cancer survivors in a supportive setting. This study assessed short-term impacts of PAVING on behavioral and psychological outcomes. Methods: 101 women who completed PAVING since 2019 were invited to complete a survey. Inclusion criteria were primary oncology treatment at Massachusetts General Hospital, age > 22, diagnosis of invasive breast cancer (Stages I-III) within past 5 years, ECOG score 0-1, and English fluency. 16 enrolled in the study, 13 of whom fully completed the survey. The REDCap survey included the REAP-S and EHQ nutrition scales, IPAQ-SQ physical activity measure, COPE Inventory for coping skills, Psychological Wellbeing Scale, PROMIS-QOL scale, and ratings of the impact of the program on well-being. Statistical analysis was completed in SPSS. Results: The participants, N = 16, were women above the age of 22 with a primary diagnosis of breast cancer. Analysis found while ASCO recommends a minimum of 150 min/week of moderate-vigorous exercise, PAVING participants achieved a median of 255 min/week (120 to 420). A Spearman’s rank correlation found a significant positive relationship between fruit intake and self-rated dietary improvement due to PAVING, r(13) = .764, p = .002. A significant positive relationship also existed between PAVING-attributed emotional well-being improvements and general mental health, r(13) = .615, p = .025. Participants strongly agreed PAVING improved their confidence in their ability to cope (M = 1.9, SD = .76) and set goals (M = 1.92, SD = .862). Participants agreed their quality of life (QOL) improved since completing PAVING (M = 2, SD = .816); QOL ratings (M = 1.69, SD = .751) reflect very good-to-excellent QOL in the average PAVING participant. Conclusions: PAVING Participants report positive lifestyle practices, many attributed to the program, supporting further investigation of this program for patients with cancer. Mental well-being, QOL, and fruit intake were all positively correlated with self-rated growth resulting from PAVING. Participants exceeded guidelines for physical activity, which has been shown to reduce risk of breast cancer recurrence. PAVING is an effective lifestyle-medicine intervention for breast cancer survivors, and expansion will enable a broader population to improve outcomes following diagnosis and treatment.