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.