View
164
Download
2
Category
Preview:
DESCRIPTION
Nundy S, Dick J, Goddu AP, Hogan P, Lu E, Solomon MC, Bussie A, Chin MH, Peek ME. Developing an Integrated Text Messaging Care Management Program for Diabetes. Poster presentation at the Midwest Regional Meeting of the Society for General Internal Medicine. September 14-15, 2012. Chicago, IL. Winner, Best Research Abstract – Poster Presentation.
Citation preview
Developing an Integrated Text Message-Based Care Management Program for Diabetes
Mobile phones are increasingly recognized as a viable
platform for improving chronic care delivery in low-
resource settings.
• Improving care for vulnerable populations:
Address patient-level barriers to medical care within the
resource constraints of current health systems
• Availability of mobile phones and text messaging:
High rates of mobile phone ownership and texting usage
among racial and ethnic minorities
How to integrate into real-world systems?
Three key challenges:
• Maintaining level of patient engagement
• Integrating with team-based care
• Identifying sustainable funding
Background
To develop a text message-based diabetes program for
University of Chicago Medicine (UCM) that could be both
sustainable and scalable.
Purpose of the Study
An iterative process of program design built upon a pilot
study and engaged multiple institutional stakeholders.
Our pilot study demonstrated high patient engagement and
satisfaction.
• 30-day intervention (n=18): automated self-management
reminders and weekly phone calls from administrator
• High engagement (80% response rate), high satisfaction,
improved confidence in self-management (p<0.002)
• Regular interaction with the text administrator important to
patient engagement.
We engaged institutional stakeholders to translate these
findings into a funded initiative.
• Primary care physicians, endocrinologists, diabetes
educators, and administrators of University-affiliated
health plan, physician's group, and medical center
• Widely recognized need to integrate with primary care
team, but concerns about demands on clinician time
• Needed protocols for clinical oversight and patient privacy
Methods
Primary Care Group
Nurse-administrators at health plan use automated text
messaging to provide personalized self-management
support for member-patients with diabetes and facilitate
care coordination with the primary care team.
• Providing self-management support:
Automated messages personalized to patient diabetes
care plan, self-management behaviors, and preferences.
• Supporting care management:
Members connect directly to nurse-care managers.
System facilitates exception-based care coordination.
• Front line health plan staff are key enablers:
Despite increased workload, frontline staff enthusiastic
about increased patient contact.
Discussion
We have developed an innovative diabetes program that
uses text messaging to provide self-management
support and augmented care management services.
• Care managers directly engage larger patient population
Automates time-consuming tasks, e.g. weekly outbound
calls or identifying members who require additional
support
• Provides the critical 'human element‘
Facilitates sustained patient engagement, while
minimizing the impact on clinic workflows.
Results
Topic Message Type Example Text Message
Medication
Prompt Reminder: Time for your medicine!
Assessment In the last 7 days how many days did you take all of your diabetes medications?
Glucose Monitoring
Education A good blood sugar within two hours after eating is less than 180 mg/dl. A good fasting (before breakfast) blood sugar is 80 to 125 mg/dl
Encouragement Monitoring blood sugars is not just so your doctor knows how you are doing. Glucose monitoring is a tool for YOU to know how you are doing.
Feedback 7 for 7, perfect job!
Nutrition
Education Corn and potatoes may be vegetables, but they are also starches that can increase your blood sugar. Stick to non-starchy vegetables like spinach and carrots.
Tip If it's not in your kitchen, you probably won't eat it. Avoid temptation by not keeping desserts or unhealthy snacks in the house.
Encouragement Developing a tasty but healthy food plan with diabetes can be hard. Diabetes educators can help. Do you want to meet with one? (yes/no)
Table 1. Sample text messages
Figure 1. Conceptual representation of the program
Shantanu Nundy MD1, Jonathan J. Dick MD2, Anna P. Goddu MSc1, Patrick Hogan BA1, Emily Lu BA3, Marla C. Solomon RD CDE4, Arnell Bussie RN MPH5, Marshall H. Chin MD MPH1, Monica E. Peek MD MPH1 1 Section of General Internal Medicine, Department of Medicine, University of Chicago. 2 College of Physicians and Surgeons, Columbia University. 3 Pritzker School of Medicine, University of Chicago. 4 Section of Pediatric Endocrinology, University of Illinois at Chicago. 5 University of Chicago Health Plan.
Acknowledgments: Dr. Nundy is supported by the Agency for Healthcare Research and Quality Health Services Research Training Program (T32 HS00084). Dr Peek was supported by the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development program and the Mentored Patient-Oriented Career Development
Award of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (K23 DK075006). Dr. Chin is supported by a Midcareer Investigator Award in Patient-Oriented Research from the NIDDK (K24 DK071933). This research was also supported by the NIDDK Diabetes Research and Training Center (P60 DK20595) and the
Chicago Center for Diabetes Translation Research (P30 DK092949).
Recommended