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Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application. Journal of Diabetes Science and Technology 2009 Alice J. Watson,Joseph C. Kvedar,Basmah Rahman,Alexandra C. Pelletier,Gregory Salber,and Richard W. Grant. Outline. Background

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Journal of diabetes science and technology 2009

Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application

Journal of Diabetes Science and Technology 2009

Alice J. Watson,Joseph C. Kvedar,Basmah Rahman,Alexandra C. Pelletier,Gregory Salber,and Richard W. Grant


Outline

Outline

  • Background

  • Research Design and Methods

  • Results

  • Discussion

  • Lessons Learned

  • Implications for Future Research


Background

Background

  • “current standard of care” frequently fails to deliver on evidence-based recommendations for practice.

  • Requirements for more transparent reporting of outcomes and new payment systems that reimburse based on outcomes rather than visit.

  • A remote blood glucose monitoring application [“DiabetesConnected Health“(DCH)]

  • Allows patients to upload glucometer readings from commercially available glucometers.


Research design and methods

Research Design and Methods

  • Both patients and providers had access to this Web site, where the data could be viewed, analyzed, and discussed.

  • Subjects were recruited from a primary care practice.

  • 20(8 decline)→12(5 ineligible)→7

  • Prominently featured a graphic representation of blood glucose readings.

  • A “journal” page allows patient to make notes and comments about each reading.


Journal of diabetes science and technology 2009

  • Provider can access to patient blood glucose readings and notes.

  • One-way messaging allowed provider to send comments to each patient.

  • Each participant was asked to upload their readings using the modem once per day.


Results

Results

  • Participant Satisfaction:

    • Five “Excellent” or “Good”

    • Remaining “Average” or “Satisfactory”


Journal of diabetes science and technology 2009

  • Patients are motivated to improve self-management because they know their provider is watching.

  • The DCH application facilitated greater communication between patient and provider.

  • The use of the product increased patients’ general awareness of their blood sugar and its changes.

  • The application would be most useful for newly diagnosed patients or during times of medication titration.


Discussion

Discussion

  • The number of comments per month increased, indicating ongoing engagement.

  • Self-monitoring is likely to be of value when test results are linked to educational or behavioral advice and changes in clinical management.


Lessons learned

Lessons Learned

  • Limitations:

    • Small sample size and short follow-up period.

    • Demography Not generalizable.

  • Shortcomings:

    • Messaging was one-way.

    • Difficult to integrate the use of the Web site to provider's workflow.

    • User wanted more flexibility in how the readings were displayed.

    • More flexibility in where and when patient could upload readings.

    • More contextual information around high or low readings.


Implications for future research

Implications for Future Research

  • Primary outcome measure will be change in HbA1c over the 6-month study.

  • Improvements:

    • Two-way messaging.

    • Integration of the program with other data sources.

    • A summary page detailing all their patients along with key metrics.

    • Customize the appearance of the graph.

    • New method of data upload via a computer.

    • Dates where medication changes were made are highlighted on the graph.


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