Empowering change: Improving self-management among food-insecure diabetics

This workshop is based on a feasibility study which describes an innovative 12-week interdisciplinary, evidence-based diabetes and obesity program using a group visit model for marginally-housed adults and adults without homes. A rapid cycle improvement process adjusted and modified the program's curriculum. Pre- and post-measures included self-efficacy, BMI, Hemoglobin A1C, BP, LDL, and smoking status. This feasibility study comprised original scholarship in adapting evidence-based practice to a unique and vulnerable population. These adaptations included applying evidence-based guidelines for measurable outcomes to a specific population, enhancing and standardizing a multifaceted program curriculum, promoting group visits, and utilizing an interdisciplinary team. In addition, the study served as a revenue generator by supplanting a typical schedule of seven patient visits in an afternoon session to billing for a one-hour multi-patient group visit. Reducing obesity among urban and marginally-housed diabetic adults as well as diabetic adults experiencing homelessness has the potential to reduce health care disparities and the incidence of serious chronic health conditions and their associated sequelae; to alleviate the burden on the health care services that result from the frequency of appointments required to manage care; and to improve the quality of life for obese patients. The study revealed that while the SF-12 detailed no significant changes between the baseline assessment and week 12 and that the participants’ Hemoglobin A1C, BMI, blood pressure, and LDL cholesterol showed no statistically significant changes during the study, positive directional trends were noted. The DES revealed improvement in individuals’ understanding of diabetes and its treatment as well as how they are able to fit diabetes into their lives in a positive manner; acknowledgement of what part(s) of taking care of their diabetes that they are not ready to change; and increased efficacy to come up with good ideas to help them reach their goals and to turn their diabetes goals into a workable plan. In the year following, several of the aspects of the study have been supplanted within various departments and workflows throughout the clinical setting. While change is typically met with some opposition, this study revealed that small, successful innovations can impact practice and promote interdisciplinary care to improve the overall quality of the care provided.