Enhancing diabetes care through care coordination, telemedicine, and education: Evaluation of a rural pilot program
- 13 March 2019
- journal article
- research article
- Published by Wiley in Public Health Nursing
- Vol. 36 (3), 310-320
- https://doi.org/10.1111/phn.12601
Abstract
Objective To provide a comprehensive evaluation of a grant‐funded pilot diabetes care program. Rural adult patients living with poorly controlled diabetes were targeted for care. Design and Sample Retrospective study using a purposive sample of patients at select primary care sites with a glycated hemoglobin (A1C) greater than 8%. Interventions included nurse care management, telemedicine endocrinology consults, as well as diabetes self‐management education (DSME), to enhance disease management and prevention of complications. Measures Pre/post labs, DSME test scores, hospital claims data, satisfaction surveys, and a focus group were evaluated. Results Fifty‐nine adults, 21–76 years of age, participated. Interventions demonstrated statistically significant reduction in A1C (10.10 vs. 9.27; p value = 0.002); DSME test score improvement (76.23 vs. 96.04; p < 0.05) and reduced hospital utilization (Emergency Department use 0.86 vs. 0.40; p value = 0.04; inpatient admissions 0.09 vs. 0.02; p value = 0.02). Patients and providers indicated strong satisfaction with the program components. Less hospital utilization reduced emergency department costs by 51.4% and inpatient costs by 96%. A rural community advisory network indicated satisfaction in delivery of program activities and outcome measures. Conclusions This rural model shows potential for improving diabetes control, access to specialty care through telemedicine, and reduction of health care utilization costs.Keywords
Funding Information
- Georgia Department of Community Health (16057G)
This publication has 20 references indexed in Scilit:
- Telehealth Technologies: Changing the Way We Deliver Efficacious and Cost-Effective Diabetes Self-Management EducationJournal Of Health Care For The Poor and Underserved, 2014
- Telemedicine for Reach, Education, Access, and Treatment (TREAT)The Diabetes Educator, 2014
- Achievement of Goals in U.S. Diabetes Care, 1999–2010New England Journal of Medicine, 2013
- Telemedicine Consultations: An Alternative Model to Increase Access to Diabetes Specialist Care in Underserved Rural CommunitiesJMIR Research Protocols, 2012
- From Acorns to Oak Trees: The Development and Theoretical Underpinnings of Diabetes Conversation Map Education ToolsDiabetes Spectrum, 2012
- Using Telehealth to Provide Diabetes Care to Patients in Rural Montana: Findings from the Promoting Realistic Individual Self-Management ProgramTelemedicine and e-Health, 2011
- Improving diabetes patient outcomes: Framing research into the chronic care modelJournal of the American Academy of Nurse Practitioners, 2010
- Evaluating the Quality of Medical CareThe Milbank Quarterly, 2005
- Improving Chronic Illness Care: Translating Evidence Into ActionHealth Affairs, 2001
- In search of how people change: Applications to addictive behaviors.American Psychologist, 1992