Date of Graduation


Document Type


Degree Type



School of Nursing


Adult Health

Committee Chair

Alvita Nathaniel

Committee Co-Chair

Julie S Bunner

Committee Member

Jennifer A Mallow


Diabetes in Appalachia is a health problem with escalating incidence and cost. The increased aging population and inadequate healthy life choices are main contributors to the diabetes epidemic. As the incidence of diabetes increases, the current one-to-one, patient-to-provider health care delivery system is insufficient to meet the needs of persons with diabetes. Furthermore, as the prevalence of diabetes increases, the access to endocrinologists in northern West Virginia becomes more limited. Increased incidence and decreased access results in poor health outcomes, increased medical costs, and patient and provider dissatisfaction with the health care system. The shared medical appointment (SMA) is an evidence-based approach to health care delivery that provides improved access to care, improved outcomes for patients with diabetes, and reduced cost, while improving patient and provider satisfaction. The purpose of this quality improvement project was to improve patient access to endocrinology care, improve adherence to the ADA standards of care, and improve patient and staff satisfaction with the health care delivery system via implementation of SMAs at an endocrinologist's office in northern West Virginia. The Chronic Care Model (CCM) was used to guide the project. Two cohorts of patients met 11 times at one month intervals. Each SMA consisted of two hour sessions, providing both individual patient-to-provider time, and group meetings. The evaluation of the project was based on increased patient access, adherence to the ADA standards of care, and patient and provider satisfaction. Access to care was increased by 38 more participants. There was no change in adherence to ADA standards of care. Both patient and staff satisfaction indicated statistically significant positive difference between patient/staff satisfaction from pre-SMA to post-SMA.