The American Telemedicine Association ATA 2017 Telehealth 2.0 Conference Abstracts.

Abstract

Telemedicine and e-HealthVol. 23, No. 4 AbstractsFree AccessThe American Telemedicine Association ATA 2017 Telehealth 2.0 Conference AbstractsPublished Online:1 Apr 2017https://doi.org/10.1089/tmj.2017.29005-A.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Jointly provided byApril 23–25, 2017Orange County Convention CenterOrlando, FLConcurrent Sessions AbstractsClinical ServicesSUNDAY, APRIL 23, 201710:15 AM–11:15 AM Sunday, April 23, 2017Session Title: USING SUBSPECIALTY TELEMEDICINE FOR LONGITUDINAL CARE NEEDS & ACCESS TO CRITICAL HEALTH SERVICESMODERATOR: Robert Caudill, MD; University of Louisville School of MedicinePresentation #: CS1-01PRESENTATION TITLE: SERVING VETERANS WHERE THEY LIVE: IMPLEMENTING VIDEO TELEHEALTH TO DELIVER EVIDENCE-BASED PSYCHOTHERAPYPRESENTER(S): Jan A. Lindsay, PhD, Baylor College of MedicineObjectives: Mental health (MH) treatment is one of the most prevalent, costly conditions for the Veterans Health Administration. Logistical and sociocultural barriers limit access to MH care for rural patients needing treatment. VA Video, which enables the connection between a VA provider and a Veteran over videoconferencing technology in their home or other remote, secure location, effectively increases Veterans' access to care, especially delivery of MH care. Disseminating telehealth in a complex healthcare system such as the VA is challenging, and development of specific implementation strategies is necessary to overcome the difficulty of bringing evidence-based treatments and new technologies that support patient care into standard practice. The overall goal of this project was to implement a VA Video to Home program to increase access to mental health care for under-served rural Veterans seeking care at the Jackson, Mississippi VA and its associated community-based outpatient clinics (CBOCs).Methods: This project was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and employed Implementation Facilitation (IF) strategies to establish a sustainable, effective home telehealth service designed to deliver EBPs, specifically to rural Veterans. The project was conducted at a VA medical center in the South Central United States, which serves a large proportion of rural Veterans. To evaluate the effectiveness of our implementation intervention, we collected patient encounter and demographics data from the national telehealth database. We calculated the slopes to capture the growth over time for the site receiving the implementation intervention and compared it to the national average.Results: Over an 18-month period, a robust video telehealth into the home service was established to provide greater access to EBPs, including Cognitive Processing Therapy, Prolonged Exposure Therapy, Interpersonal Therapy, and Cognitive-Behavioral Therapy for depression, anxiety, and insomnia are among the evidence-based psychotherapies being conducted via VA Video. Eighty-seven Veterans (85% rural) received mental health treatment via VA Video for nearly 500 visits. We were able to reach a diverse population, including women (29%), a broad range of ages (21-72) and more than 50% ethnic minority Veterans. Compared to national average, the growth in VA Video to the Home visits was 5-times greater (p < .0001).Conclusion: To our knowledge, this is the first prospective study of facilitation as an implementation strategy for telehealth into the home. Our findings suggest that implementation facilitation is an effective and acceptable strategy to support providers as they establish clinics and make complex practice changes, such as implementing video telehealth to deliver psychotherapy.REFERENCES:1. Lindsay JA, Kauth MR, Hudson S, Martin LA, Ramsey DJ, Daily L, Rader J. (2015). Implementation of video telehealth to improve access to evidence-based psychotherapy for posttraumatic stress disorder. Telemed J E Health, 21(6), 467-472.2. Kauth MR, Shipherd JC, Lindsay JA, Kirsh S, Knapp H, Matza L. (2015). Teleconsultation and training of VHA providers on transgender care: Implementation of a multisite hub system. Telemed J E Health, 21(12), 1012-1018.3. Acierno R, Gros DF, Ruggiero K.J, Hernandez-Tejada BM, et al. (2016). Behavioral activation and therapeutic exposure for posttraumatic stress disorder: a noninferiority trial of treatment delivered in person versus home-based telehealth. Depression and anxiety.Presentation #: CS1-02PRESENTATION TITLE: RHEUMATOLOGY CARE USING TELEMEDICINEPRESENTER(S): Shima Roshani, MD, Emmam Zaman Hospital; Lawrence Brent, MD, Einstein Medical Center Of Philadelphia; Jonathan Hardy, B.S. in Biochemistry, Rural Outreach Arthritis Center; Michael M. Rezaian, MD, Board Certified Rheumatologist, West Virginia UniversityObjectives: People living in many parts of the world have limited access to diagnostics and treatments for rheumatologic, musculoskeletal and connective tissue diseases. The challenge has been particularly poignant for rural areas of low- and middle-income countries. We report on the implementation of a Telemedicine program in rural areas near the border of Afghanistan for the evaluation and treatment of patients with rheumatologic and musculoskeletal disease. More than 4800 patients were seen remotely over a span of five years by a rheumatologist in the United States. The remote rheumatologist was aided by a general physician and a nurse at a local charity hospital that has a catchment that includes rural areas extending to the border of Afghanistan. Seventy to 90 patients were evaluated online via by the remote rheumatologist three days a week. A subset of patients were evaluated by the rheumatologist in person every 4 months.Methods: The population of rheumatology patients was evaluated using descriptive statistics. Information collected included demographic information consisting of age, gender, and primary diagnosis.Results: The average age of patients that were seen was 52 years and 89% of patients were women. Approximately 50% of patients were Afghan refugees. The most common disorders included osteoarthritis (1149, 23.6%), rheumatoid arthritis (653, 13.4%), axial spondyloarthropathies (647, 13.3%), lumbar spinal stenosis (427, 8.8%), meniscal tear of the knee (326, 6.7%), and psoriatic arthritis (217, 4.5%). Certain conditions were lower than expected such as lupus (19, 0.4%) and fibromyalgia (169, 3.5%). Diagnostic tests serology (1328, 27.3%), radiographs (946, 19.5%), Magnetic Resonance Imaging (899, 18.5%), Bone Densitometry (147, 3.0%), and Nerve Conduction Study (132, 2.7%). The most common medications prescribed were NSAIDs (791, 16.3%), methotrexate (764, 15.7%), pregabalin (234, 4.8%), duloxetine (230, 4.7%), sulfasalazine (177, 3.6%), etanercept (97, 2.0%), tofacitinib (64, 1.3%), adalimumab (18, 0.4%), and infliximab (9, 0.2%).Conclusion: Telemedicine is becoming more popular. We report the successful use of this service in the evaluation and management of rheumatic diseases in a region with limited access to care. We have shown that patients can be seen, evaluated, and successfully treated with a variety of medications including biologic agents.Presentation #: CS1-03PRESENTATION TITLE: BIG DATA, AUTOMATION, DEEP LEARNING, AND THE FUTURE OF TELEOPHTHALMOLOGYPRESENTER: Kenman Gan, MD FRCSC, University of British ColumbiaFirst, we review the definitions of and concepts behind big data, automation, and deep learning. Second, we introduce how these concepts are being applied to teleophthalmology. Third, we discuss how the lessons learned can be extrapolated to applications in other medical specialties.Teleophthalmology offers a unique opportunity to implement digital concepts in healthcare, due to (1) the very high prevalence of ocular diseases such as diabetic retinopathy, macular degeneration, and glaucoma that can be evaluated with store-and-forward telemedicine; and (2) the worldwide shortage of eye care professionals in both first world and developing countries.We present Care1, one of the largest teleophthalmology programs in the world. Based in Western Canada, dozens of healthcare providers are connected to deliver over 10,000 patient interactions every year. Canada has a unique need for teleophthalmology due to an alarming shortage of eye care professionals, and a population that is spread out over a very large geographic expanse.In order to deliver the highest level of care to very large numbers of patients, telemedicine is combined with software to maximize the time efficiency for healthcare professionals, allowing each single provider to deliver care to many more patients.Existing scientific literature on the software-led provision of medical care has performance rates that are not high enough to be universally accepted by most healthcare professionals. The primary reasons for this include the overly strict application of automated medical algorithms on one end of the spectrum, and the overgeneralized application of machine learning and neural networks at the other end.We demonstrate outstanding acceptance rates among healthcare professionals in the software-led provision of eye care, by utilizing a hybrid concept of both extremes, “Medically Architected Deep Learning”. Automation is applied to frameworks of diagnosis and treatment, for which there should be no variation. Deep learning and neural networks are then applied to individual facets within the automated framework, allowing artificial intelligence to superimpose the more subjective and provider dependent aspects of medical care. The result is software that is able to make profound diagnostic and treatment recommendations that have very high rates of alignment with clinical decisions made by healthcare professionals. Healthcare professionals benefit from improved efficiency, as it allows them to deliver much greater quality of care to a much larger number of patients. Clinical impact is exponential when these software benefits are applied to telemedicine networks.The unique nature of ocular disease means that teleophthalmology is the ideal launching point into healthcare, for the most exciting and important technological concepts of the digital age.SUNDAY, APRIL 23, 201711:30 AM–12:30 PM Sunday, April 23, 2017Session Title: TELEPEDIATRIC OUTCOMES: A PROSPECTIVE & RETROSPECTIVE ASSESSMENTMODERATOR: Karen Rheuban, MD; University of VirginiaPresentation #: CS2-01PRESENTATION TITLE: USE OF A RESEARCH COLLABORATIVE MODEL TO STUDY OUTCOMES AND UTILIZATION OF PEDIATRIC TELEHEALTHPRESENTER(S): John Chuo, MD, MS, IA, Children's Hospital of Pennsylvania; Steven D. McSwain, MD MPH, Medical University of South Carolina; Christina A. Olson, MD, Children's Hospital Colorado; Alison Curfman, MD, Washington University in St. LouisObjectives: Describe the Value of Learning Collaboratives for the Study of Telemedicine-related Healthcare Quality Outcomes and Share Early Lessons Learned from Formation of the Standardized Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT) Collaborative.Methods: Three PubMed searches were completed on title keywords: Community, Multicenter, Multi state, Collaborative, Learning, Models, IHI, Breakthrough, Quality Improvement, Research. Results were further filtered by Individual inspection to identify publications related to multi-center, multistate, and community collaboratives utilized for research or quality improvement. Operational mechanisms of these collaboratives were identified and incorporated into the creation of the SPROUT collaborative. The purpose of SPROUT is to create a national registry of pediatric telehealth programs across the country and provide a collaborative research backbone for conducting quality outcomes research for pediatric telemedicine. Initial efforts by the SPROUT team consisted of establishing vision and goals, identifying stakeholder participation and participating institutions, creation of a web presence, and design of the first project.Results: Literature review yielded a final list of 104 publications. Common findings of operational mechanisms for these collaboratives were related to human resources, key operational processes, and various tools used for implementation. Currently, SPROUT consists of 81 institutions and 134 members from 32 states. In collaboration with the American Academy of Pediatrics Section on Telehealth Care and the American Telemedicine Association Pediatrics Special Interest Group, the first study will assess infrastructural components of pediatric telehealth programs at various stages of maturity. We will share results from our initial study, “Identifying Critical Infrastructural Elements of Pediatric Telemedicine Implementation,” which aims to identify key system components for a successful telemedicine program. Future SPROUT projects will assess the impact of subareas in Pediatric Telehealth on healthcare triple aim outcomes related to population health, care experience, and cost.Conclusion: Research collaboratives are organization structures that answer difficult clinical outcomes questions by leveraging the combined multicenter contribution of subject matter expertise, operational resources, and the required experimental units for substantive power. These organization structures are traditionally used not only in multicenter clinical trials, but also quality improvement efforts that become more powerful when executed as collaboratives. This model has value for assessing pediatric telemedicine efforts nationwide. SPROUT is a collaborative network that conducts prospective research on pediatric telehealth and provides telemedicine investigators with dynamic learning laboratories that can deliver results quickly so that the integration of telemedicine into healthcare delivery can evolve in a data driven manner.Presentation #: CS2-02PRESENTATION TITLE: A MIXED METHODS STUDY ON THE BARRIERS AND FACILITATORS OF TELEMEDICINE FOR NEWBORN RESUSCITATIONPRESENTER(S): Jennifer Fang, MD, MS, Mayo Clinic, Division of Neonatal Medicine; Katherine Carroll, PhD, Australian National University; Christopher Colby, MD, Mayo Clinic, Division of Neonatal Medicine; Gladys Asiedu, PhD, Mayo Clinic; Ann M. Harris, Mayo ClinicObjectives:1. Understand provider perceptions and use of telemedicine for newborn resuscitation (termed teleneonatology).2. Identify potential barriers to implementation and use of teleneonatology services.3. Recognize local initiatives that optimize inclusion of teleneonatology into the local practice.Methods: In March 2013, Mayo Clinic's Division of Neonatal Medicine began offering telemedicine consults to support local providers during high-risk newborn resuscitations. From 10/2015 to 06/2016, we conducted a mixed methods study to understand facilitators and barriers to the use of teleneonatology services. In October 2015, electronic surveys were sent to 349 physicians and nurses at six health system sites that received teleneonatology services. The survey remained open for three months, and two reminder emails were sent to non-respondents at two week intervals. The survey assessed frequency of telemedicine use, reasons for non-use, user satisfaction, and perceived value. Following the survey, focus groups (9) and individual semi-structured interviews (4) were conducted with provider volunteers between 12/2015 and 06/2016. These methods were used to gain an in-depth understanding of acceptability and utilization of teleneonatology services, the importance of telemedicine in newborn resuscitation, barriers that may impact service use, and practice improvement suggestions.Results: The survey response rate was 31.8% (n = 111 respondents). Fifty percent of respondents (n = 56 of 111) had used the teleneonatology service. Of the non-users (n = 55), 65% didn't use the service because they did not have a clinical need (n = 36). However, 44.4% of users (n = 24 of 54) thought there were times when teleneonatology could have been used but was not. Ninety percent of teleneonatology users (n = 49 of 54) were satisfied with the experience; 96% (n = 50 of 52) felt the consult was helpful. Eighteen physicians and 31 nurses participated in focus groups/ interviews. Barriers to the use of teleneonatology included differences in expectations for activation, variable interactions with the neonatologist, additional time and staffing needed for use, and fears around incompetency. To optimize inclusion of teleneonatology into local practices, participants suggested providing frequent staff training, continuously reassuring providers that competencies are not being assessed, and selecting technology that is very simple to use.Conclusion: Our teleneonatology program has a high level of user satisfaction and is viewed as an important, helpful service by local care teams. There are inconsistencies regarding if and when to activate the service. This may be due to multiple factors including changes to local workflows that require extra time and staff, usability of the technology, and provider concerns about being perceived as incompetent. Health systems establishing teleneonatology programs should strive to select a technology that is reliable and easy-to-use, provide frequent training to both local care teams and consulting neonatologists to ensure an effective telemedicine interaction, and create a culture of safety that is encouraging to all providers.Track: Clinical ServicesSUNDAY, APRIL 23, 20171:45 PM–2:45 PM Sunday, April 23, 2017Session Title: SOLVING LIFE THREATENING & CRITICAL NEONATAL AND YOUNG CHILD HEALTH CONDITIONS WITH PEDIATRIC TELEMEDICINEMODERATOR: Madan Dharmar, MD, MBBS; UC Davis Health SystemPresentation #: CS3-01PRESENTATION TITLE: TeleNICU: CREATING A SUSTAINABLE RURAL TeleNICU PROGRAM - A REAL WORLD CASE STUDYPRESENTER: Nina M. Antoniotti, RN, MBA, PhD, SIU Health CareIn Southern Illinois, very few hospital organizations deliver babies and when those organizations do, very few actually are capable of caring for a high risk newborn. Even in delivery, more often than not, no advanced practice clinician is available to help assist with the neonate if there are problems at the time of delivery. There are approximately 165,000 births in Illinois, with 8.3 percent being low birth weight (<2,500 grams) and 2 percent being very low birth weight (<1,500 grams). Ten percent of births are preterm (<37 weeks) and 31 percent of births either are scheduled or result in emergency cesarean section. Forty percent of births are to mothers who are unmarried and 15 percent of births are to mothers who did not graduate high school, increasing the likelihood of poor socio-economic and health status and less than optimum prenatal care. Fifteen thousand births were to mothers under the age of 20 and another 35,000 between the ages of 20 and 24. Six thousand births are twin births and 250 or more births per year are three or more babies. The infant mortality rate is 6.8 percent, higher than the U.S. infant mortality rate of 6.1, and ranking the state 27th in the world. This presentation focuses on an approach to providing TeleNICU services between a private practice.Neonatology group and rural facilities who are Level I or Level II Nurseries. The development of the program will be covered which will explain the initial planning phase, development of a TeleNICU agreement, identification of appropriate nursery locations of telehealth equipment, the options for selecting and using telehealth equipment, what patient peripherals must be in place to conduct a full physical exam of the newborn, training of NICU nursing staff, clinical protocol development and other critical elements to implementing the program. Of specific interest to the learner will be a review of easy and practical methods for sharing health information and images when necessary, how to get documentation back to the referring NICU without complicated EHR interfaces, and selection of cost effective technologies that are easily integrated into the NICU environment. Outcome metrics will be shown including the number of newborn evaluations conducted, time from referral to evaluation (minutes), the number of transfers avoided and the cost/revenue implications of such, and the costs and risk/complications avoided when transfers are expedited. In addition, other pediatric subspecialties will be introduced that complement the work done by the Neonatology team. Participants in birthing hospitals and those with a higher than normal emergency department birth rate will benefit from learning how to implement a cost effective TeleNICU program that maximizes return on investment for families, birthing hospitals, and neonatology groups.Presentation #: CS3-02PRESENTATION TITLE: APPLICATION OF TELEMEDICINE TO ADDRESS SERVICE GAPS FOR YOUNG CHILDREN WITH ASD IN RURAL COMMUNITIESPRESENTER: Alacia Stainbrook, PhD, BCBA-D, Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders (VKC TRIAD)The increasing prevalence of ASD (CDC, 2012) brings more demand for diagnostic and early intervention services. Research suggests early diagnosis and subsequent early intervention services play a significant role in facilitating optimal outcomes for children with developmental delays and disabilities (Carter et al., 2011; Dawson et al., 2012; Rogers et al., 2012). Despite significant needs for diagnostic and behavioral services, access can be challenging; many children, particularly those from underrepresented groups, are still not diagnosed until after 48-months (CDC, 2012). Similarly, early intervention providers with ASD and applied behavior analysis (ABA) expertise are difficult to access in many communities (Mello et al., in press) due to shortages of providers, cost of services, and ability to travel to access services. Recently, behavioral assessments as well as caregiver and provider training for treating individuals with developmental delays and disabilities has been conducted via telemedicine (Marturana & Woods, 2012; Wacker at al., 2013).Program Description: In an effort to address the service gap for families of children with ASD in rural communities, a telemedicine model of service delivery has been developed through a partnership between a university-based center for ASD and state department of education. This program facilitates access to diagnostic evaluations through the establishment of three clinical sites in rural areas of Tennessee where families may access a diagnostic screening for ASD. Components of the consult include 1) administration of the Screening Tool for Autism in Toddlers and Young Children (STAT) onsite by an Early Intervention Provider or Behavioral Specialist, and 2) remote observation, parent interview, and feedback by a licensed university-based psychologist.Following evaluation, families and their Early Intervention Providers engage in 6 intervention sessions guided by a Behavioral Specialist, focusing on the application of ABA to address a specific area of need as identified by the family (i.e., challenging behavior reduction, increased functional communication). Early Intervention Providers were engaged in an effort to build capacity of state-funded providers to support families of children with ASD. The intervention sessions includes a combination of in person and remote Behavioral Specialist support.Results and Conclusion: Average caregiver satisfaction ratings with the telemedicine diagnostic procedure were 4.8 on a 5-point scale where 5 equals “Strongly Agree”. In addition, families saved an average of 3 hours in travel time. Following participation in intervention services, caregivers reported improvements in child performance with an average rating of 3.2 on a 7-point scale with 1 equaling “Very Much Improved”. Caregivers and children also demonstrated improvement across individualized goals related to social communication and behavior. Finally, satisfaction ratings for intervention services were high with an average score of 3.0 on a 3-point scale with 3 equaling “Agree”. These outcomes suggest telemedicine may serve as a strategy for ameliorating the service gap for families in rural communities.REFERENCES1. Carter AS, Messinger DS, Stone WL, et al. (2011) A randomized controlled trial of Hanen's 'More Than Words' in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry 52(7), 741-752.2. Mello MP, Goldman S, Urbano RC, Hodapp RM. (in press). Services for children with autism spectrum disorder: Comparing rural and non-rural communities. Education and Training in Autism and Developmental Disabilities.3. Marturana ER, Woods JJ. (2012). Technology-supported performance-based feedback for early intervention home visiting. Topics in Early Childhood Special Education, 32(1), 14-23.SUNDAY, APRIL 23, 20173:00 PM–4:00 PM Sunday, April 23, 2017Presentation #: CS4-01PRESENTATION TITLE: TECHNOLOGY INTERVENTIONS FOR CAREGIVERS OF VETERANS: DESIGN, OUTCOMES, AND LESSONS LEARNEDMODERATOR: Stuti Dang, MD, MPH; Miami VA Healthcare SystemPRESENTER(S): Constance Uphold, PhD, North Florida/South Georgia Veterans Health System; Patricia C. Griffiths, PhD, Atlanta Department of Veterans Affairs Medical Center/GRECC/CVNR; Randall Rupper, MD, MPH, Salt Lake VA Geriatric Research Education and Clinical CenterAfter attending this session, participants will be able to:1) Describe different technology-enabled interventions that may help caregivers.2) Describe how different technology-enabled interventions can be used to improve quality of life and outcomes of caregivers of older veterans.3) Enumerate factors that impact acceptance and adoption of technologies in the home environment.4) Reiterate potential logistical issues in the implementation and evaluation of technology based interventions for caregiving dyads.5) Discuss lessons learned and the research, policy, and clinical implications of using technology-enabled interventions in caring for older adults.Methods: The CCHT program for Dementia Caregivers was implemented in 2009 and available nationally to all Veterans Health Affairs facilities. The Dementia Disease Management Protocol or (DMP) is a set of algorithmic questions delivered to patients via Home Telehealth technology that assess the symptoms, educational needs and self-management status of the patients and caregivers. The Dementia DMP questions are sent to the caregivers daily and the questions elicit responses that enable the Care Coordinator to assess patients' health status trends and triage any concerns regarding caregiver burden and depression. The patient responses to these questionnaires determine the type of care coordination interventions and education the patients and caregivers receive.Results: We will assess the use of the CCHT Dementia DMP for the last 5 years in the Veterans Health Affairs using the national VA data, patterns and trends in use, and patient and caregiver outcomes, including caregiver burden, depression, and patient outcomes including ADL and IADL status. We will identify the challenges with the use of home telehealth technology in this group of caregivers and future directions.Conclusion: The four presentations in this panel will highlight the intervention's designs, challenges faced in implementing the caregiving interventions, focusing on the role of technology and its impact on improving patient and caregiver outcome. The symposium will conclude by synthesizing the lessons learned and discussing the research, policy, and clinical implications of the technology-enabled projects. The lessons learned can guide future studies.MONDAY, APRIL 24, 201710:15 AM–11:15 AM Monday, April 24, 2017Session Title: PREVENTION & LONG TERM CARE USING REMOTE PATIENT MONITORINGMODERATOR: Mark VanderWerf, Nonin Medical, Inc.Presentation #: CS5-01PRESENTATION TITLE: REMOTE PATIENT MONITORING IN RURAL MISSISSIPPIPRESENTER(S): Megan T. Duet, MS, UMMC Center for Telehealth; Michael Adcock, FACHE, Center for Telehealth, University of Mississippi Medical CenterThe University of Mississippi Medical Center's Center for Telehealth launched The Mississippi Diabetes Telehealth Network in August 2014 to pilot an advanced healthcare model on patients with uncontrolled diabetes living in the Mississippi Delta. At the Center for Telehealth, our active multidisciplinary team works together to provide individual disease management plans for patients which would not otherwise have access to this type of care without telehealth. By providing access to our telehealth network, this program is helping improve care coordination and strengthening connections between clinicians and patients beyond the walls of a hospital in a way which is reducing the use of higher acuity clinical settings, such as the ER.Presentation #: CS5-02PRESENTATION TITLE: REMOTE INTERVENTIONS IMPROVING SPECIALTY COMPLEX CARE (RIISCC) FOR PATIENTS WITH TYPE 2 DiABETESPRESENTER(S): Robert Schwab, MD, University of Nebraska Medical Center; Geri M. Tyson, MSN, RN, Nebraska MedicineObjectives: Payers continue to be concerned about the continual increase in the cost of caring for complex patients. This CMMI-funded project is focusing specifically on (all-cause) hospitalized patients with Type 2 diabetes and identifying the potential impact of active remote patient monitoring services for this population. Objectives include: 1. Describe the increasing prevalence of diabetes and its cost to the economy. 2. Provide a description of RIISCC, which is a CMMI-funded remote patient monitoring program for patients with diabetes. 3. Provide estimates of the effect of RIISCC on diabetes health outcomes and patient engagement and satisfaction.Methods: This is a one-group pre-post study with a sample size of 552 patients with diabetes recently discharged from Nebraska Medicine. The study star