Grant Application

Tammie Payne, RN, MS, CDE, UPMC Bedford Memorial in partnership with Linda Siminerio, RN, PhD, CDE

Proposed Innovation

Address limited access to team-based care and support for diabetes patients in rural communities by introducing shared decision-making materials (SDM) and aids. Team-based care has proven to be the best predictor for improvements in glucose control. For many patients in outlying areas, telemedicine is their first exposure to team care and to an active role in decision making.


The team designed, produced, and implemented shared decision-making aids and training-program materials to help patients manage glucose and related lifestyle considerations. Patients and providers were shown how to engage as a team despite being located at multiple sites. Program fidelity was ensured through supervision of shared decision- making approaches during telemedicine visits.


The health care team was trained on the shared decision-making process. In addition, the SDM process and aids were successfully integrated and implemented into telemedicine visits with diabetes patients. Patients and providers reported that the aids useful in communicating the meaning of HbA1C levels (a measure of glucose control), as well as the benefits and risks of glucose control.

Participants also reported that the tools helped facilitate conversations between team members and patients, and enhanced patient behavioral goal setting. Although it cannot be directly associated with SDM, HbA1C levels have improved significantly. In addition, patients said they have a better understanding of diabetes and feel empowered.

As a result of the progress experienced to date, the model was expanded to another telemedicine site (UPMC Northwest) and adapted for use by the Endocrine Diabetes Center (Falk Clinic). The telemedicine project was featured on local television news and presented at a national diabetes convention; project findings were published in a scientific journal for clinicians.