Everest Erica, Akhtar Sara, Sumego Marianne, Zeizoun Alaa, Worley Sarah, Tang Anne S, Dorsey Allison, Smith Ann, Schweiger Bahareh
Case Western Reserve University School of Medicine, Cleveland, Ohio (Ms Everest); and Department of Pediatric Endocrinology, Cleveland Clinic Children's Hospital, Cleveland, Ohio (Drs Akhtar, Sumego, and Zeizoun and Mss Worley, Tang, Dorsey, Smith, and Schweiger).
Qual Manag Health Care. 2016 Jul-Sep;25(3):181-4. doi: 10.1097/QMH.0000000000000097.
Shared medical appointments began in the United States in 1996 to advance quality of care and enhance patients' ability to self-manage. Group visits gather patients with the same diagnosis for individual examinations followed by group education sessions taught by the provider. This leads to the opportunity to learn from the experiences of others. The Cleveland Clinic Department of Pediatric Endocrinology offers a shared medical appointment group for pediatric patients with type 1 diabetes called the ESCALAIT clinic (Enrichment Services and Care for Adolescents Living with Autoimmune Insulin Dependent Type 1 Diabetes). The objective of this study was to compare the effectiveness of traditional clinic visits with shared medical appointments for adolescents with type 1 diabetes in terms of hemoglobin A1c (HbA1c) improvement. Eighty ESCALAIT patients, aged 11 to 19 years were compared with 516 clinic controls of the same age. Visits were approximately 3 months apart for both patient groups. Changes in HbA1c between groups were calculated from the first to fourth visits. There was a statistically significant difference between the ESCALAIT clinic patients and the control patients. Our results revealed that the group visit patients had less improvement in HbA1c values at the last visit approximately 1 year later, but we would argue that the difference is not clinically significant. However, there were many benefits to shared medical appointment visits including increased access to care as well as peer support. Shared medical appointments are therefore a valid alternative to traditional clinic visits in this patient population.
共享医疗预约于1996年在美国开始，旨在提高医疗质量并增强患者的自我管理能力。小组就诊将患有相同诊断的患者聚集在一起进行个体检查，随后由医护人员进行小组教育课程。这带来了从他人经验中学习的机会。克利夫兰诊所儿科内分泌科为1型糖尿病儿科患者提供了一个共享医疗预约小组，称为ESCALAIT诊所（为患有自身免疫性胰岛素依赖型1型糖尿病的青少年提供丰富服务和护理）。本研究的目的是比较传统门诊就诊与共享医疗预约对1型糖尿病青少年糖化血红蛋白（HbA1c）改善效果的差异。将80名年龄在11至19岁的ESCALAIT患者与516名同龄的门诊对照患者进行比较。两组患者的就诊间隔约为3个月。计算两组患者从第一次就诊到第四次就诊期间HbA1c的变化。ESCALAIT诊所患者与对照患者之间存在统计学上的显著差异。我们的结果显示，大约1年后的最后一次就诊时，小组就诊患者的HbA1c值改善较少，但我们认为这种差异在临床上并不显著。然而，共享医疗预约就诊有许多好处，包括增加获得医疗服务的机会以及同伴支持。因此，在这一患者群体中，共享医疗预约是传统门诊就诊的一种有效替代方式。
