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Dr. Cunningham's corresponding dissertation can be found at


Type 2 diabetes is increasing in incidence and prevalence, and contributes to significant morbidity, mortality, and costs. Type 2 diabetes management is complex and requires continual patient self-management. However, many physicians lack the time and training to deliver comprehensive diabetes self-management training to their patients, and only 56.8% of individuals with Type 2 diabetes have received formal diabetes education.

Group medical visits (GMVs), which combine one-on-one clinical consultations and group self-management education, have emerged as a promising vehicle for supporting type 2 diabetes management. This dissertation used a quasi-experimental nonequivalent groups design to evaluate the four-session Diabetes Information and Support for your Health (DISH) program at Jefferson Family Medicine Associates (JFMA).

DISH participants were compared to a group of non-participating subjects with type 2 diabetes at JFMA on baseline demographics. Next, propensity score matching was used to match DISH participants with a comparison group DISH participants and the matched group were then compared for changes in hemoglobin A1c (HbA1c), systolic blood pressure, low-density lipoprotein cholesterol, and body mass index, and compared on their change trajectories. A sub-analysis also examined the HbA1c change of the initial cohort of DISH participants from 2009. DISH participants and the matched comparison group were also compared on rates of retinal exam completion and nephropathy screening, and on the mean number of primary care visits, emergency department visits, and hospital admissions in the 1-year time period following DISH participation.

This study’s contributions include: (a) an evaluation of a group visit program in a predominantly African American population; (b) an evaluation of an established group visit program in a primary care practice; (c) the use of data derived from electronic medical records for group visit evaluation; (d) a comparison of group visit participants and nonparticipants; (e) an analysis of group visits’ impact on HbA1c, systolic blood pressure, low-density lipoprotein cholesterol, and body mass index change and change trajectories, including 5-year HbA1c change; and (f) an analysis of group visits’ impact on processes of care and utilization. Findings on the clinical outcomes and costs of the DISH program can be used to inform future DISH iterations at JFMA. Finally, the results may have implications for health policy, specifically chronic illness care models and group visit reimbursement.



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