Exploring the use of personal health records in diabetes management a pilot study
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Exploring the Use of Personal Health Records in Diabetes Management A Pilot Study. Linda Wells Freiberger , FNP-C, MSN. Acknowledgments.

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Exploring the use of personal health records in diabetes management a pilot study

Exploring the Use of Personal Health RecordsinDiabetes ManagementA Pilot Study

Linda Wells Freiberger, FNP-C, MSN


Acknowledgments
Acknowledgments

The project described was supported by 1 U56 AE000012-01 from the Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health and Human Services.


Contextual background jubilee community health
Contextual BackgroundJUBILEE COMMUNITY HEALTH

  • A nonprofit(501c3) health clinic established in 1999 in Paoli, Indiana

  • Mission: To provide low fee-for-service primary care to uninsured populations

  • Partially supported through IU Health-Paoli and local community grants

  • Self-pay population for health care


Diabetes costs
Diabetes Costs

  • Estimated costs associated with diabetes as of 2007(NIH, 2011)


Diabetes
Diabetes

  • Diabetes is a serious, costly and preventable chronic disease in the US.

    • As of 2010, 25.8 million(8.3%) have been affected in the US (NIH, 2011).

    • In 2011, 10.1% of Indiana adults reported having some form of diabetes(ISDH, 2012).

    • Racial/Ethnic and socioeconomically disadvantaged groups experience the steepest increases and the most substantial effects from diabetes (Beckles et al, 2011)


Study goal and objectives
Study Goal and Objectives

  • Goal

    • To explore the use of a PHR by rural, uninsured patients with diabetes

  • Objectives

    • Texting and PHR use to improve glucose outcomes

    • Shared care between clinician and patient using PHR

  • Methodology

    • Use of a convenience sample (N=28)

    • Pre/Post Variables Examined

      • A1c

      • Glucose levels


Results
Results

  • Early findings –

    • most were attempting use within 1 month

    • After 6 months 35.7% were actively engaging in PHR use and recording glucose readings







Immediate feedback
Immediate Feedback

Normal Glucose Message

High Glucose Message


Benefits of engagement
Benefits of Engagement

  • H. H.

    • “Oh, I will just go to the library and enter my sugar readings.”

    • Home PC failed during the study

    • Unable to afford A1c levels

    • Continued testing and entering glucose levels in PHR

    • Improved glucose: 370 110-120 mg/dl


Benefits of engagement1
Benefits of Engagement

“I stopped eating bags of candy at one time.” K. P.


K c the super engaged patient
K.C. The Super Engaged Patient


Ed visits admissions
ED VISITS & ADMISSIONS

6 Months Prior

6 Months Post

7 ED visits

Trauma x 2

Chest pain x 2, MI x 1

Abdominal mass

Extended psych med/suicidal ideation

4 Admissions

  • 1 ED visit

  • 1 Admission


Burden of poor engagement and inadequate self care management
Burden of Poor Engagement and Inadequate Self-care Management

  • S. B. Suffered Acute MI with stent placement in September 2012

    • Estimated cost stent $12,978

    • Estimated hospitalization cost $5,151

    • Estimated ED visit charges $334

      • *Estimated Direct Variable Costs = $18,463


Cost exercise
COST EXERCISE Management

$20,000

Estimated cost 1 patient MI with stent

$1,840,000

Estimated cost of treatment 1 uninsured patient per county in Indiana


Burden of poor engagement and poor self care management
Burden of Poor Engagement and Poor Self Care Management Management

  • E. C. Suffered amputation of a toe

    • Estimated total cost $11,271

      • Physician $876.00

      • Hospital 9880.00 (~1800.00 per day)

      • Anesthesia 515.00 (1 hour, 15 minutes) (http://www.healthcarebluebook.com)


Outcomes
Outcomes Management

  • Enhanced patient – clinician engagement

  • Potential to improve clinical outcomes of patients with diabetes

  • Uninsured populations can use Health Information Technology (HIT) tools to improveself-care management of chronic disease

  • Potential to reduce health care costs



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