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Diabetes Specialty Clinic: An Intervention to Improve Care for Veterans

Homa, Karen PhD; Detzer, Mark PhD; Morgan, Jennifer MS; Derry, Elizabeth RD, CDE; Merrill, Lou Ann RN, CDE; Whitley, Christina S. PsyD; Aaron, Jason MD, MPH

doi: 10.1097/QMH.0b013e31827decaa
Original Articles

Objective: People with diabetes who have chronically higher than normal blood glucose levels are at risk for a variety of health conditions, such as kidney failure, blindness, amputation, and a shortened life expectancy. At a Veterans Health Administration Medical Center (White River Junction, Vermont), a team of providers, diabetes educators, and psychologist noticed that patient education and therapy sessions were not effective for some patients and in addition the center had above the benchmark percentage of veterans who had higher than normal blood glucose levels. The team thought a new approach might work better and through feedback from staff and primary care providers developed the Diabetes Specialty Clinic (DSC). Our working theory was that veterans would make changes in diabetes self-management and improve their levels of blood glucose by sharing their experiences with other veterans in a supportive environment.

Methods: Both quantitative and qualitative methods were used to evaluate whether the DSC had a positive impact with the veterans. Hemoglobin A1c was obtained at the first group meeting and at 6 weeks, 6 months, and 1 year, along with 5 patient-reported outcomes obtained using 4 questionnaires.

Results: Thirty-nine veterans participated in the DSC. For the veterans who participated in the DSC for more than a year, 42% of the measures showed improvement, and they shared positive feedback on how the DSC influenced their behaviors by helping them engage in self-care activities.

Conclusion: The DSC seemed to be effective in creating a space for establishing relationships, resolving issues, and understanding the management of diabetes for veterans and health care professionals.

Leadership Preventive Medicine Residency Program, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Homa); White River Junction VA Medical Center, White River Junction, Vermont (Drs Detzer and Aaron and Mss Derry and Merrill); University of Central Florida College of Medicine, Orlando (Ms Morgan); The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Drs Detzer and Aaron); and Robert J. Dole VA Medical Center, Wichita, Kansas (Dr Whitley).

Correspondence: Karen Homa, PhD, Leadership Preventive Medicine Residency Program, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756 (

The VHA New England Innovation Grant Award by the Veterans Administration funded this quality improvement work. The authors acknowledge Donna M. Pelkey, LPN, for her excellent coordination of the Diabetes Specialty Clinic that was essential in this improvement work, and Primary Care Nurse Manager Sandy McLaughlin, RN, for her collaboration and administrative support.

None of the authors have any financial interest or commercial associations to disclose.

©2013Lippincott Williams & Wilkins, Inc.