Original Article

Integration of Personalized Health Planning and Shared Medical Appointments for Patients with Type 2 Diabetes Mellitus

Authors: Connor Drake, MPA, Caroline Meade, BS, Sharon K. Hull, MD, MPH, Ashley Price, PhD, MPH, Ralph Snyderman, MD


Objectives: This study describes the feasibility of implementing personalized health planning (PHP) within shared medical appointments (SMAs) for patients with type 2 diabetes mellitus. The PHP-SMA approach was designed to synergize the benefits of SMAs with those of PHP, enabling greater patient engagement focused on meeting individualized therapeutic goals in a group setting.

Methods: Patients were assigned randomly to a PHP-SMA or a standard eight-session SMA series. Standard SMAs included an interactive educational curriculum delivered in group medical encounters. The PHP-SMA included the addition of a patient self-assessment, health risk assessment, shared patient-provider goal setting, creation of a personal health plan, and follow-up on clinical progress. Clinical and patient-reported outcomes and qualitative data from focus groups with patients, providers, and administrative staff were used for evaluation. Qualitative data explored facilitators and barriers to implementation of the PHP-SMA. The Consolidated Framework for Implementation Research was used to provide insight into implementation factors.

Results: PHP was successfully integrated into SMAs in a primary care setting. Patients in the PHP-SMA (n = 12) were more likely to attend ≥5 sessions than patients assigned to the standard SMA (n = 7; 58% PHP, 28.5% control). Qualitative data evaluation described the advantages and barriers to PHP, the team-based approach to care, and patient participation. The PHP-SMA group experienced reductions in hemoglobin A1c, low-density lipoprotein, blood pressure, and body mass index, as well as successful attainment of health goals.

Conclusions: The PHP-SMA is a proactive and participatory approach to chronic care delivery that synergizes the benefits of PHP within SMAs. This study describes the components of this intervention; collects evidence on feasibility, acceptability, and clinical outcomes; and identifies implementation barriers and facilitators. The PHP-SMA warrants further evaluation as an approach to improve health outcomes in patients with common chronic conditions.


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1. Levine JA. Poverty and obesity in the U.S. Diabetes 2011;60:2667-2668.
2. Wagner EH, Austin BT, Davis C, et al. Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001;20:64-78.
3. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q 1996;74:511-544.
4. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 2003;26:1-7.
5. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences fewer data on costs. Health Aff (Millwood) 2013;32:207-214.
6. Hibbard JH, Stockard J, Mahoney ER, et al. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res 2004;39(4 Part 1):1005-1026.
7. Fisher EB, Earp JA, Maman S, et al. Cross-cultural and international adaptation of peer support for diabetes management. Fam Pract 2010;27(suppl 1):i6-i16.
8. Peers for Progress. What is peer support? http://peersforprogress.org/learn-about-peer-support/what-is-peer-support. Published 2017. Accessed March 8, 2017.
9. American Diabetes Association. Standards of medical care in diabetes-2016. http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf. Published 2016. Accessed September 6, 2018.
10. Peikes D, Genevro J, Scholle S, Torda P. The patient-centered medical home: strategies to put patients at the center of primary care. https://pcmh.ahrq.gov/page/patient-centered-medical-home-strategies-put-patients-center-primary-care. Published 2011. Accessed September 6, 2018.
11. Snyderman R. Personalized health care: from theory to practice. Biotechnol J 2012;7:973-979.
12. Snyderman R, Drake CD. Personalized health care: unlocking the potential of genomic and precision medicine. https://www.thejournalofprecisionmedicine.com/wp-content/uploads/2015/10/SNYDERMAN.pdf. Published October 2015. Accessed September 6, 2018.
13. Edelman D, Oddone EZ, Liebowitz RS, et al. A multidimensional integrative medicine intervention to improve cardiovascular risk. J Gen Intern Med 2006;21:728-734.
14. Burnette R, Simmons LA, Snyderman R. Personalized health care as a pathway for the adoption of genomic medicine. J Pers Med 2012;2:232-240.
15. Musich S, Klemes A, Kubica MA, et al. Personalized preventive care reduces healthcare expenditures among Medicare Advantage beneficiaries. Am J Manag Care 2014;20:613-620.
16. Simmons L, Drake C, Gaudet T, et al. Personalized health planning in primary care settings. Fed Pract 2016;33:27-34.
17. Edelman D, Gierisch JM, McDuffie JR, et al. Shared medical appointments for patients with diabetes mellitus: a systematic review. J Gen Intern Med 2015;30:99-106.
18. Housden LM, Wong ST. Using group medical visits with those who have diabetes: examining the evidence. Curr Diab Rep 2016;16:134.
19. Ramdas K, Darzi A. Adopting innovations in care delivery-the case of shared medical appointments. N Engl J Med 2017;376:1105-1107.
20. Damschroder LJ, Goodrich DE, Robinson CH, et al. A systematic exploration of differences in contextual factors related to implementing the MOVE! weight management program in VA: a mixed methods study. BMC Health Serv Res 2011;11:248.
21. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the Patient Activation Measure. Health Serv Res 2005;40(6 Part 1):1918-1930.
22. Anderson RM, Funnell MM, Fitzgerald JT, et al. The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy. Diabetes Care 2000;23:739-743.
23. DeSalvo KB, Jones TM, Peabody J, et al. Health care expenditure with a single-item, self-rated health measure. Med Care 2009;47:440-447.
24. Arroll B, Goodyear-Smith F, Crengle S, et al. Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med 2010;8:348-353.
25. Hibbard JH, Mahoney ER, Stock R, et al. Do increases in patient activation result in improved self-management behaviors? Health Serv Res 2007;42:1443-1463.
26. Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med 2012;27:520-526.
27. Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs delivery systems should know their patients’ ‘scores’. Health Aff (Millwood) 2013;32:216-222.
28. Hibbard JH, Greene J, Shi Y, et al. Taking the long view: how well do patient activation scores predict outcomes four years later? Med Care Res Rev 2015;72:324-337.
29. Mitchell SE, Gardiner PM, Sadikova E, et al. Patient activation and 30-day post-discharge hospital utilization. J Gen Intern Med 2014;29:349-355.
30. Anderson RM, Fitzgerald JT, Gruppen LD, Funnell MM, Oh MS. The Diabetes Empowerment Scale-Short Form (DES-SF). Diabetes Care 2003;26:1641-1642.
31. DeSalvo KB, Bloser N, Reynolds K, et al. Mortality prediction with a single general self-rated health question: a meta-analysis. J Gen Intern Med 2006;21:267-275.