Diabetes Disease Management Program for an Indigent Population Empowered by Telemedicine Technology

Abstract

Mercy Health Center in Laredo, Texas implemented a Telemedicine Diabetes Disease Management Program to determine the impact of a web-based patient interface technology as part of a diabetes disease management program. The program featured the use of the Health Hero iCare Desktop and the Health Buddy appliance. The Mercy Health Center outcomes study aimed to assess the effect of telemedicine technology on the health of indigent border residents with diabetes. The study was conducted in calendar year 2000-2001 using comparative cohort data from calendar year 1999. Using the technology, patients were monitored daily at home, and to ensure early intervention, nurses were alerted if patients reported abnormalities. The goals of the program were to decrease hospital-based resource utilization, improve patient compliance with treatment plans, improve the level of patient satisfaction with healthcare services, and improve patients' perceived quality of life. Objective outcomes, including inpatient admissions, emergency room visits, postdischarge care visits, and outpatient visits, as well as charges for healthcare services, were all measured on a per patient per year basis. Subjective outcomes, including quality of life and patient satisfaction, were estimated from surveys conducted before, quarterly for two quarters within the program, and at the end of the study period. For each measure except for quality of life, comparisons were made between the year just prior to and the year of Health Buddy utilization. Quality of life was compared for the year just prior to Health Buddy utilization and at the end of the second quarter. After 1 year, reductions in overall utilization and charges, as well as improvements in quality of life, were demonstrated. Patients in the program showed reduced overall charges of 747 dollars per patient per year. Inpatient admissions were reduced 32% (p < 0.07), emergency room encounters were reduced 34% (p < 0.06), postdischarge care visits were reduced 44% (p < 0.28), and outpatient visits were reduced 49% (p < 0.001). Quality of life was assessed using the Medical Outcomes Study 12-item Short Form health survey. The mean improvement in the mental component after 6 months in the program was 2.8, from 45.1 preprogram to 47.9 within the program (p < 0.0264). The mean improvement in the physical component after 6 months in the program was 2.1, from 41.7 preprogram to 43.8 within the program (p < 0.0518). The reductions in utilization and improvement in quality of life can likely be attributed to the patient's enhanced self-management behaviors and the nurse's ability to intervene in a timely manner when warranted. Without technology and daily remote monitoring, standard patient care is based on episodic encounters between patients and their care providers, which does not allow for prevention, education, or early intervention. This program bridged the gap between office visits for the patients. The early intervention ultimately reduced the cost of care.

The Feasibility of Computerized Patient Self-assessment at Mental Health Clinics

“…Its use of audio can reduce literacy concerns. ACASI systems have been shown to improve care for a variety of chronic medical diseases, including hypertension (Cummings, Frisof, Demers, & Walsh, 1985), obesity, renal disease (Rogers, Haring, Wortman, Watson, & Goetz, 1982), high cholesterol (Boekeloo, Becker, Levine, Belitsos, & Pearson, 1990), diabetes (Cherry, Moffatt, Rodriguez, & Dryden, 2002) and asthma (Guendelman, Meade, Benson, Chen, & Samuels, 2002). In one study, ACASI reduced barriers to routine data collection and improved care in persons with SMI who were prescribed lithium (Feldman, Wilner, & Winickoff, 1982).…”

A Meta-Synthesis of Behavioral Outcomes from Telemedicine Clinical Trials for Type 2 Diabetes and the Clinical User-Experience Evaluation (CUE)

“…For example, sample recommendations such as BPlease, decrease the long acting insulin by two units^, BPlease add one tablet of sulfonylurea in the evening^, BLack of exercise may be the cause of the aggravated glucose level^and BYour glucose control seems to be good^etc., can be sent using the mobile phone SMS service [62]; & Transfer of data via modem followed by telephone counseling -methods used in earlier periods before the Internet was widely available [63]; & Automated Telephone Disease Management (ATDM) -a telephone-based system where patients receive calls at predetermined times and listen to self-management tips navigated via the telephone keypad [64] and the modern version where phone calls are automated to emulate the conversation with a physician [65]; & Glucometer modem transfer followed by graphical report generation [52]; & Data entry of touch tone telephone followed by voice message from clinicians [66]; & Interactive programs on CD Rom to educate on selfmanagement [67]; & Web-based programs on self-management including chat room forums to enlist strangers as supporters [68] the iCare Desktop, the Health Buddy appliance web interfaces Fig. 2 Methodology of paper selection for the meta-synthesis [69], web-based diabetes management systems [70] and the Internet Based Glucose Monitoring System (IBGMS) [71],; & Teleconferencing -a person to person connection via telephone [72]; and & Pro-active call center treatment support -a telephonebased system where conversation is not automatic like the ATDM. The conversation takes place with trained non-medical operators [73] Training, setup and maintenance of the clinical trial technologies…”

“…There were two withdrawals reported by Rutten et al [60] due to lack of motivation to adhere to the self-monitoring. The studies by Lavery et al [82], Cherry et al [69] and Biermann et al [63] did not report any dropouts. Izquierdo et al [72] reported several patients who did not send the data in time so were withdrawn by default.…”

e-ESAS: Evolution of a participatory design-based solution for breast cancer (BC) patients in rural Bangladesh

“…CHESS, 15 a complex patient archival system, has been deployed in the USA. The effectiveness of electronic symptom monitoring has been proven in chronic diseases such as asthma, 1 diabetes 8 and cancer. 10 Handheld devices (mobile phones, PDA, etc.)…”