C3EN #2

Abstract

Of the 30 million adults with DM in the United States, 97% have at least one comorbid condition (e.g. hypertension, heart disease, kidney disease). DM and DM-related complications disproportionately affect people of color. The prevalence of DM is higher among Hispanics (12.5%) and African-Americans (11.7%) compared to non-Hispanic whites (7.5%); Hispanics and African-Americans have higher rates of diabetes-related complications, including amputations and CKD. Group visits (GVs) can provide patients with comprehensive care for their multimorbid chronic condition. Diabetes GVs—shared appointments where patients receive self- management education in a group setting and an individual medical visit—can improve glycemic control, decrease healthcare utilization, and provide social support and co-learning among peers. While virtual appointments have become a routine part of clinical care during the COVID-19 pandemic, group visits via virtual platforms remain uncommon and understudied. Before the model can be widely adopted, important questions about the effectiveness and implementation of the virtual diabetes GV model need to be addressed.

We propose to build on an established program of in-person diabetes GVs and a virtual diabetes GV pilot by the University of Chicago and MidWest Clinician’s Network. We aim to implement the virtual GV model (VIDA: Virtual Diabetes Group Visits Across Health Systems) in two distinct health systems in the Chicago region: ACCESS and Advocate Aurora Health (AAH). ACCESS is one of the largest federally qualified health centers (FQHCs) in the U.S. with 35 sites across the Chicago metropolitan area, providing care for 175,000 medically underserved and low-income patients each year, including over 25,000 patients with diabetes. Advocate Aurora Health (AAH) is a large, diverse, integrated private not-for profit health system with more than 129 primary care clinics in Illinois serving over 117,000 patients with diabetes. The ability to train, implement and evaluate virtual group visits across two distinct health systems provides a unique opportunity to learn about adaptation and the barriers and facilitators for program implementation.

This study will use a type I hybrid effectiveness-implementation design via a pragmatic cluster randomized trial to assess changes in clinical outcomes among adults with T2DM in virtual diabetes GVs versus usual care. We will first adapt and implement VIDA at one ACCESS FQHC center and one AAH primary care clinic using the Form and Function domains of the Complex Health Intervention Framework. We will assess integration of VIDA into clinical workflow and determine the type of and amount of training and technical support needed to assist staff in integrating virtual diabetes GV into the clinical setting. We will then conduct a pragmatic cluster randomized trial of virtual GVs across 9 intervention sites (180 adult patients with T2DM with A1C >9%) and 9 control sites (360 matched patients) and assess change in A1C from baseline to 12-months and change in other clinical outcomes including systolic blood pressure and body mass index. We will assess adoption, implementation, and maintenance of virtual GVs across systems using RE-AIM framework.