DO - Ohio University College of Osteopathic Medicine

quality
Research
of care
Improving the
By Susan Green
It’s no secret that type 2 diabetes is on the rise.
According to the Centers for Disease Control, 1 in 3
people born in the United States in 2000 will develop
diabetes in their lifetime. And over the next 50 years
as those who develop diabetes continue to do so
at a younger age, the number of people in nursing
homes with diabetes will also increase due to the
complexity of the disease in an aging population.
“The fastest growing population of young people
with diabetes is in this region,” says Rachel Holt, a
second-year medical student at OU-COM. “Imagine
the implications of this.”
To examine the implications, Jay Shubrook, D.O.
(’96), and Frank Schwartz, M.D., both affiliated
with the Appalachian Rural Health Institute Diabetes
Center at Ohio University, designed a research study
to look at the quality of care diabetes patients receive
in nursing homes. Holt joined the project in its early
phase and was instrumental in its completion.
The goal of the study was to examine physician
management of patients with type 1 and type 2
diabetes residing in extended care facilities and to
compare this management to the American Diabetes
Association Standards of Care for outpatients.
After reviewing patient charts of more than 100
elderly residents with diabetes in 11 nursing homes
in Ohio and West Virginia, the researchers discovered
that patients who had their diabetes under control
either as outpatients or while hospitalized, had less
success after entering a nursing home.
Holt says an analysis of the data revealed the lack
of a systematic approach to diabetes treatment in the
facilities studied. The findings demonstrate that practice
guidelines for this population are needed.
Working closely with medical directors and directors
of nursing, Schwartz and Shubrook are developing
specific guidelines regarding the care of diabetes in
the nursing home population. “The guidelines give
physicians and nursing home staff a solid framework
for developing treatment plans for this challenging
population,” Shubrook says. “Phase 2 of the study,
a second chart review of patients, will determine if
following the treatment protocols results in quality
of life changes for the residents.”
This project is an excellent example of how the
RSAF program gives medical students like Holt an
opportunity to conduct valuable research. “I really
enjoy research and had done basic science bench work,
but I wanted to try clinical research,” she says. “And
Dr. Shubrook’s project was a good fit. Next year I’ll
be doing a family practice fellowship and will continue
to work on phase 2 of the nursing home study.”
As Holt’s research advisor, Shubrook gives her
credit for the success of the project. He says she
kept the project on track, analyzed the data and was
the lead author on their research paper published in
Diabetes Care.
“The college is very supportive of research
opportunities for students by helping us navigate
our way through the process,” Holt adds. “Being
here at OU-COM is advantageous. Through this
experience and others, I’ll be better prepared to
do my residency.”
Holt RM, Schwartz FL, Shubrook JH. Diabetes Care
in Extended Care Facilities: Appropriate Intensity of
Care? Diabetes Care. 2007 Jun;30(6):1454-1458;
DOI: 10.2337/dc06-2311.
From left, Jay Shubrook, D.O., Rachel Holt and Frank
Schwartz, M.D.
24 www.oucom.ohio.edu