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Click here to subscribe to HRET Resources RSS feed Living with Diabetes Project

Harold I. Goldberg, MD, University of Washington Gretchen Murphy, RHIA, MEd, University of Washington James D. Ralston, MD, University of Washington Allen Cheadle, PhD, University of Washington Irl Hirsch, MD, University of Washington Mary Alice Hanken, RHIA., PhD, CHP, University of Washington Debra Revere, MLIS, University of Washington - October 08, 2010

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With more than half of the nation’s health care dollar spent on behalf of patients with multiple chronic diseases, health care delivery systems must develop strategies that will improve their patients’ ability to manage health problems such as high blood pressure and diabetes.  The Living with Diabetes Project examined the economic impact and effectiveness of two technology-based programs aimed at helping patients with type 2 diabetes manage their health.

The Living with Diabetes Project evaluated the effectiveness and economic impact of two programs created to help patients with type 2 diabetes manage their health between clinic visits.  One program used a computerized diabetes registry and telephone reminder system as part of a traditional pharmacist outreach program.  The other involved a Web-based diabetes care module developed by the Living with Diabetes Project.  The research team also surveyed Center for Health Management Research member organizations to determine their readiness to implement the technologies necessary to support both provider-centered electronic health records functionality and patient-centered exchange of data from home.

Pharmacy Outreach

To evaluate the economic impact of the computerized diabetes registry and telephone reminder system, researchers examined the care provided to 185 patients with diabetes who regularly used the Family Medicine Center at the University of Washington.  During the three-year program conducted by the Living with Diabetes Project, the Center’s pharmacists received special training in the use of standardized diabetes treatment algorithms.  They were then provided with monthly computerized reports on the diabetic patients.  The reports included rates-compliance with recommended process measures (such as semi-annual HbA1c determinations and annual retinal examinations) as well as patients’ interim visit dates and corresponding HbA1c levels.  With primary physicians providing oversight, pharmacists telephoned patients who were not adequately controlling their disease or who had missed important exams.  They encouraged patients to make appointments, as appropriate, with their physician, a nurse educator, or a nutritionist.

Despite the difficulties inherent in reaching patients by telephone, the results of the pharmacy outreach program proved that—when combined with personal outreach—basic technology such as a computerized registry can have a positive effect on health care.  The pharmacy outreach program lowered the percentage of diabetic patients with an HbA1c level of > 8% (the American Diabetic Association’s definition of “unacceptable” treatment) by 16.  Because of the reduction in symptoms and complications, patients visited the Center on fewer occasions.  Over the two years following the conclusion of the program, the average number of monthly ambulatory visits was reduced by 16%—an annual per-patient savings of 2.5 visits.

Web-based Module

Following the pharmacist outreach program study, researchers with the Living with Diabetes Project developed a Web-based diabetes care module that tested the feasibility of allowing patients to co-manage their disease from home.  With nurse-practitioner case managers reviewing all information weekly, the disease-management module enabled patients to:

  • view their entire electronic medical record;
  • upload blood glucose readings from a digital meter;
  • enter daily medication, nutrition, and exercise information into an online diary;
  • use a clinical e-mail service to communicate with providers regarding treatment recommendations;
  • obtain additional information from an on-line education site.
Technology Implementation

Finally, the Living With Diabetes Project surveyed Center for Health Management Research member organizations to asses information technology and security readiness for both traditional provider-centered electronic health records functionality and patient-centered exchange of data from home in between office visits.  Results indicated that members are developing the computer infrastructures necessary for implementing electronic health records, but only a few are ready to host an Internet-based chronic disease management application.  Although findings by the Living With Diabetes Project make a strong case for the adoption of Internet co-management programs, fewer than half of member organizations are working to bring technology to managing diabetes care.  Still, more than half of those surveyed reported a readiness to adopt one of the key premises of the project–enhanced patient role in their own care.

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