Diabetes has reached epidemic numbers in the United States. The National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) has determined the prevalence of diabetes in the U.S. to be 23.6 million or 7.7% of our nation’s population. Diabetes mellitus is a chronic illness that can be quite debilitating for the patient, the patient’s family, as well as the current health care system. Too frequently patients are informed they have diabetes and yet are given very little information about the disease and how to effectively manage it. Patients are seen by their provider for a median of 16 minutes, every 3 months, thus allowing very little time for the patient to ask questions or obtain education. By providing these patients with the necessary skills to manage diabetes, they become empowered to take change of this disorder, thus minimizing the risk of both short and long-term complications often associated with diabetes. The McColl Institute for Healthcare Innovation developed the Chronic Care Model (CCM). This renowned healthcare model recognizes the important elements necessary to promote high-quality chronic disease management. The elements of this model include self-management, decision support; the delivery system design; the community, the organization of health care and clinical information systems. With the implementation of the CCM, patients are more informed and therefore more motivated to manage their health and the healthcare team more efficiently delivers evidence-based care tha that the patients that is culturally appropriate and useful. For the implementation of an evidence-based practice change, the theoretical framework of Rosswurm and Larrabee was utilized for this capstone project. Additional explanation of this framework is found later in this paper. This capstone project focused on three aspects of the CCM: the delivery system design, the health system, and self-management. Group office visits were offered to those patients with type 2 diabetes who were at that time, seen in the traditional one-on-one office visit. In 2008, a survey intitled Assessment of Chronic Illness Care, developed by the MacColl Institute for Healthcare Innovation, was completed at a rural health clinic in northern California. The purpose of the survey was to determine the status of health care provided in the clinical setting. The clinic’s overall score indicated there was limited support for chronic illness care in the organization. Beginning in January 2010, six groups of patients with type 2 diabetes were formed, each limited to three participants. Each group met for three visits once every three months over a six-month period. After the completion of every group office visit, the patients completed a patient satisfaction questionnaire. The group visit format was extremely well accepted, each of the participants stated they preferred this method of healthcare delivery of the management of diabetes. Based upon the outcomes of this capstone project, it is recommended that patients with diabetes mellitus be offered the choice of participating in group office visits of the traditional one-on-one visits for the management of their chronic illness. Patients benefit by learning to manage diabetes by implementing lifestyle change and gaining peer support from others in the group. In addition, providers are more efficient and productive, thus more satisfied as well.
