2001 — Group Medical Visits: Approaches to their Implementation and Evaluation

Edelman D (Durham HSR&D), Melnyk SD (Durham HSR&D), Kirsh SR (Cleveland VAMC), Goldstein MK (Palo Alto HSR&D)

Workshop Objectives:
Group Medical Visits are used in a large number of VAMCs across the country. They are perceived as enhancing both the efficiency and quality of care. However, there are a wide range of group medical visit models from which to choose, and most models remain scientifically untested, especially in VHA settings. Implementation research approaches may be ideally suited for the assessment of these complex, already-in-use interventions. Our objective is to present a number of barriers to both group visit implementation and group visit implementation research, and some solutions to those barriers. Some of the barriers and solutions will be specific to group visit assessment, but others will generalize easily to implementation research for evaluating other health services interventions.

Activities:
The workshop will be a structured panel discussion with opportunity for dialogue throughout. David Edelman, Principal Investigator of an HSR&D funded diabetes group visits study, will present a brief overview of group medical visit models and the theory and background literature supporting or refuting the efficacy of each model. Drs. S. Dee Melnyk and Susan Kirsh, who manage and study diabetes group visits, will present a session on organizational barriers and solutions in group visit implementation. Mary K. Goldstein, Principal Investigator of an HSR&D funded hypertension group visit study, will present the “staircase step” approach to evaluating new models of care such as group visits and will discuss some challenges in implementation research on quality improvement strategies highlighting contrasts between studies that target providers only and those that target patients. Dr. Edelman will conclude with a discussion of analytic dilemmas in evaluating group interventions, including specifically accounting for variability in a complex intervention and addressing the clustering structure that can arise from typical study designs.

Target Audience:
Researchers, clinicians, and managers interested in implementation and/or implementation research regarding medical group visits.

Assumed Audience Familiarity with Topic:
Basic understanding of chronic illness management, basic understanding either of implementation research or of actual implementation of complex health interventions.