Study compared shared and individual appointments for patients with chronic conditions
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In a study of the functional medicine model, Cleveland Clinic researchers found that functional medicine-based shared medical appointments (SMAs) improved patient outcomes as compared to care delivered in individual appointments and were less costly to deliver. The study was published today in BMJ Open.
The Cleveland Clinic Center for Functional Medicine offers a shared medical appointment program called Functioning For Life® (FFL), a 10-week SMA designed to address various chronic conditions through the use of food as medicine. By the end of the program, patients are empowered to make positive decisions regarding food and become advocates for healthy lifestyles within their homes and communities.
Michelle Beidelschies, Ph.D.
The retrospective cohort study, which was conducted from March 1, 2017, to Dec. 31, 2019, included 2,455 patients (226 SMAs and 2,229 individual appointments), aged 18 or older. Patients were propensity score-matched (1:1) with 213 per group based on various demographic and biometric factors. Patients’ health-related quality of life (PROMIS®) and biometrics (weight and blood pressure) were assessed over time as well as the cost to deliver care in each setting. The primary outcome of the study was the change in PROMIS GPH at three months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics and cost.
Researchers found that patients seen in the SMA program exhibited significantly greater improvements in PROMIS Global Physical Health and Global Mental Health than patients in individual appointments at 3 months. Additionally, more patients seen in the SMA program improved their PROMIS Global Physical Health scores by 5 points or more compared to those seen in an individual appointment. An improvement of 5 points or more is considered a clinically meaningful change or a noticeable effect on daily life.
patients also experienced greater weight loss than patients in individual appointments; however, both groups experienced similar improvements in systolic blood pressure. It also was found that SMAs were less costly to deliver care than individual appointments.
“This study is a first-of-its-kind to demonstrate that functional medicine-based care can be efficiently delivered in a shared medical appointment setting and contribute to improved patient outcomes even beyond those achieved in an individual appointment setting. This innovative and transformative model redesigns the way we think about conventional healthcare delivery, and leverages a community setting to empower patients as they make needed nutrition and lifestyle changes to improve their quality of life,” said Michelle Beidelschies, Ph.D., director of Research and Education for the Cleveland Clinic Center for Functional Medicine and the lead author of the study.
In 2014, Cleveland Clinic became the first academic medical center to open a Center for Functional Medicine. Functional medicine looks at the body as a whole and focuses on the root causes of disease rather than an isolated set of symptoms. It’s based on the evidence that lifestyle factors – such as nutrition, sleep, exercise, stress levels, relationships and genetics – are major contributors to chronic disease. Cleveland Clinic’s Center for Functional Medicine requires that all new patients see a registered dietitian and health coach, in addition to a provider as part of their initial visit. Patients also have the option to meet with a behavioral health therapist as part of any visit.
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. Cleveland Clinic is consistently recognized in the U.S. and throughout the world for its expertise and care. Among Cleveland Clinic’s 81,000 employees worldwide are more than 5,743 salaried physicians and researchers, and 20,160 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,690-bed health system that includes a 173-acre main campus near downtown Cleveland, 23 hospitals, 276 outpatient facilities, including locations in northeast Ohio; Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2023, there were 13.7 million outpatient encounters, 323,000 hospital admissions and observations, and 301,000 surgeries and procedures throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 132 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/CleClinicNews. News and resources available at newsroom.clevelandclinic.org.
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