{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T14:26:03Z","timestamp":1782483963326,"version":"3.54.5"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"5-6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Defense Health Agency directs that military Medical Treatment Facilities provide Patient-Centered Medical Home (PCMH) services within its Internal Medicine and other Primary Care clinics. Development and documentation of self-management goals for chronic diseases within the electronic medical record (EMR) is a PCMH accreditation standard through the Joint Commission. This quality improvement project aimed to implement a structured approach to creating and documenting SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) goals for patients with Type 2 Diabetes Mellitus (DM) in a military-affiliated Internal Medicine clinic. Although SMART goals have demonstrated clinically meaningful reductions in hemoglobin A1c (HbA1c), the effects of SMART goals on patient perceptions of their health and self-management of their DM have not been fully studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This study voluntarily enrolled 62 patients aged 19-90 with DM and HbA1c &amp;gt;8% (64 mmol\/mol) within the previous 6-month period from a military-affiliated Internal Medicine clinic. Exclusion criteria included patients following with a subspecialist for DM management. Enrolled patients developed and discussed SMART goals with their physician using a standardized goal-setting tool for self-management of their DM. These goals were documented in the EMR for longitudinal follow-up between patients, physicians, and the clinic care team. HbA1c and patient self-reported health perceptions were evaluated before and after 3 months of participation in this intervention. Data analysis used a 2-tailed paired samples t-test. The study protocol underwent Institutional Review Board examination and was determined not to constitute research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 62 patients enrolled, 36 completed post-surveys and were included in the statistical analysis. Results showed a statistically significant reduction in HbA1c levels, with a mean decrease from 9.18% (77.2 mmol\/mol) to 7.84% (62.7 mmol\/mol) (P\u2009&amp;lt;\u20090.001). Patient-reported perceptions of their health, goal-oriented behaviors, perceived ability to influence health through lifestyle changes, and responsibility for self-management of their DM did not change significantly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This quality improvement project further highlights the importance of self-management goals in improving biomedical outcomes and disease management markers. Despite a significant improvement in HbA1c, no changes were observed in patient-reported health perceptions. Overall, patients indicated high adherence and positive feedback with this intervention. The goal-setting tool and standardized documentation strategy as implemented are a viable strategy for satisfying a PCMH accreditation standard. Future studies could address limitations such as single-site design, response rates, and review specific effects on perceptions with the use of validated survey instruments. Similar self-management interventions can be applied to other chronic diseases where daily lifestyle choices influence outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaf407","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T11:37:11Z","timestamp":1753961831000},"page":"e1327-e1332","source":"Crossref","is-referenced-by-count":1,"title":["Diabetes Self-Management Goals in an Internal Medicine Clinic: A Quality Improvement Initiative"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7005-2881","authenticated-orcid":false,"given":"Robert W","family":"Buntyn","sequence":"first","affiliation":[{"name":"Internal Medicine Clinic, Wright Patterson Medical Center, Wright Patterson AFB , OH 45433,","place":["United States"]},{"name":"Department of Internal Medicine and Neurology, Wright State University Boonshoft School of Medicine, Miami Valley Hospital , Dayton, OH 45409,","place":["United 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