LEADER (Learning Expedited through Audiovisual Directed Education by Residents)

From the 2018 HVPAA National Conference

Rajpreet Singh (Mount Carmel West), Lynn Shaffer (Mount Carmel West), Perry Lin (Mount Carmel West), Rishi Kora (Mount Carmel West), Sagar Gandhi (Mount Carmel West), Kelly Hanson (Mount Carmel West), Diana Zellner (Mount Carmel West), Karampal Mand (Mount Carmel West), Jonthan Burton (Mount Carmel West), Johonna Asquith (Mount Carmel West)


Poor health literacy correlates with lower socioeconomic status and education, and increases healthcare expenses. Diabetic patients with limited health literacy have A1c% higher than those with proficient literacy. Residency clinics are poised for literacy interventions given a patient population typically below the poverty level and commonly having diabetes.


To develop a streamlined, effective education intervention for improving patients’ diabetes knowledge, skills and outcomes and which can be incorporated into the current model of delivery in an internal medicine residency clinic.


Outpatients visiting MetroWest Clinic November 1st, 2016 to January 15th, 2017 received a questionnaire at check in covering diabetes-related knowledge, perception and self-care behavior topics.   Patients with diabetes also viewed an educational five-minute video prior to interaction with a physician. After video education patients with diabetes answered the same survey prior to leaving clinic.  HgbA1c values prior to and after video viewing were evaluated for trends via individual profile plots.  McNemar’s test compared pre- and post-video answers.


296 unique patients visited the clinic and completed the survey; of these 51 (17.2%) had diabetes. Three of four knowledge questions showed improvement among patients with diabetes, including:  1) use of A1c for screening (78% to 94%, p=0.0047); 2) A1c target of 6 (39% to 59%, p=0.0075); and 3) A1c should be checked every 3 months (41% to 63%, p=0.0076). Additionally, 27.4% of patients with diabetes either did not check blood sugar at home or had daily readings >200. Only 21.57% of diabetic patients exercised daily, and 21.57% never exercised.  18% of patients without, and 9.8% of patients with diabetes stated they would like more information about diabetes. At subsequent follow up visits a downward trend was noted in the individual A1c% along with a narrowing range of A1c overall correcting those who were inappropriately low and those with uncontrolled diabetes.


Our residency clinic patients with and without diabetes have poor understanding of the disease and its management.  Our intervention, albeit with a small sample size, has shown that already-scheduled visits to the PCP can serve to provide health education with the goal towards improving outcomes and limiting health care costs.

Implications for the Patient

There is increasing demand for healthcare to provide effective and efficient education and prevention. Our intervention increases value by allowing for education and prevention during underutilized time at an already-scheduled patient visit. Our video education is customizable and tailored to patient population and barriers

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