Shared Medical Appointments: Impact on Clinical and Quality Outcomes in Veterans With Diabetes

Qual Manag Health Care. 2016 Jul-Sep;25(3):176-80. doi: 10.1097/QMH.0000000000000098.


Managing diabetes poses substantial challenges to the over 29.1 million Americans afflicted, and is financially overwhelming to the US health care system. One potential strategy is utilizing a group approach to care delivery or shared medical appointment (SMA). The purpose of this 3-year retrospective VA study was to investigate differences in clinical and quality outcome measures in veterans with type 2 diabetes who used SMAs and those who received only usual care (UC) one-on-one with their doctor. This observational, 2-group cohort study used abstracted medical records from a large Midwestern Veterans Administration hospital. Clinical outcome metrics included hemoglobin A1c (hbA1c), systolic blood pressure, low-density lipoprotein cholesterol, and emergency department (ED) visits. Quality outcomes included Veterans' Administration (VA) Department of Defense clinical practice guidelines for the management of diabetes. A total of 988 total VA cases were examined retrospectively over 3 years: 371 cases had used SMAs and 617 were in the UC cohort, and had never attended a diabetes SMA. The study period used abstracted VA medical records from 2008 to 2010. There were no statistically significant differences in HbA1c, systolic blood pressure, and ED visits between groups; however, hbA1c for individuals who attended SMAs was 8.55 (standard deviation [SD] = 1.72) and UC was 7.49 (SD = 1.28) (P < .001). All clinical outcomes were worse at baseline for the SMA cohort. UC had mean ED visits/3 years (mean = 18.62, SD = 13.53, P < .001) versus SMA participants (mean = 27.97, SD = 14.00, P <. 001), revealing a propensity for high health care utilization. SMA providers had statistically significant differences over UC cases on quality measures, including ordering annual ophthalmology and podiatry examinations (P < .001) and prescribing aspirin and angiotension-converting enzyme inhibitors (ACE-I). SMAs may provide a venue for assessing and delivering quality care for patients with type 2 diabetes. More research is needed to ascertain effective strategies for diabetes disease management in high-risk patients.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Appointments and Schedules*
  • Blood Pressure
  • Cholesterol, LDL / blood
  • Comorbidity
  • Diabetes Mellitus, Type 2 / therapy*
  • Disease Management*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Glycated Hemoglobin
  • Guideline Adherence
  • Humans
  • Male
  • Middle Aged
  • Patient Care Team / organization & administration
  • Practice Guidelines as Topic
  • Primary Health Care / organization & administration*
  • Quality Indicators, Health Care
  • Retrospective Studies
  • Socioeconomic Factors
  • United States
  • United States Department of Veterans Affairs
  • Veterans*


  • Cholesterol, LDL
  • Glycated Hemoglobin A