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BACKGROUND/RATIONALE:
Patients with diabetes and elevated HbA1c are at the greatest risk for diabetes-related complications. Care-management may be helpful in these patients- by providing direct contact between such high-risk patients and the healthcare system. A web-based system might neutralize access barriers to care management such as scheduling and travel to appointments and be of particular help in improving diabetes care.
OBJECTIVE(S):
We will examine the efficacy and cost-effectiveness of two methods of diabetes education and care management- a traditional model that involves face-to-face encounters and telephone contact and an Internet-based model using a diabetes care management web site. We will compare these interventions to a usual care control group that receives no education or care management but is provided with Internet access.
METHODS:
This study employs a randomized, prospective, parallel group design involving patients with diabetes mellitus. Primary outcome measures include clinical data (e.g. HbA1c, blood pressure, quality of life questionnaires) and secondary outcome measures include economic data (e.g. costs of case management, medication usage, and number(s) of ER visits/hospitalizations during the study period).
We will study 150 participants with elevated HbA1c (³ 8.5%). Over 12-months we will measure HbA1c, office BP, and scores on the Problem Areas in Diabetes (PAID) questionnaire and Center for Epidemiologic Studies Depression Scale (CES-D). Participants receiving usual care will receive a notebook computer and Internet access. Those assigned to Internet-based care management will receive a notebook computer, Internet access and will interact with a care manager through a diabetes education and care management web site. Those receiving traditional care management will interact with a care manager following a structured contact schedule. Both care management models will employ medication algorithms to improve glucose and BP control, with the secondary goal of also improving diabetes-related stress and depression. We will collect data on process measures and health care utilization in order to conduct exploratory analyses on the cost-effectiveness of these interventions.
FINDINGS/RESULTS:
There are no findings at present
IMPACT:
Care management program that delivers specialized services to patients with poorly controlled diabetes mellitus may ultimately reduce the drain on resources from diabetes and its complications. An Internet-based care management model may prove to be more cost-effective can be delivered directly to patients in their home. Such a clinical initiative that successfully improves compliance with clinical guidelines will improve the care of such high-risk patients.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Communication and Decision Making, Resource Use and Cost
Keywords:
Diabetes, Managed care, Telemedicine
MeSH Terms:
none
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