Diabetes Mellitus
Conditions
Brief summary
This proof of concept study proposes to evaluate the feasibility of a communications-technology-based chronic care and patient relationship management program to improve diabetes self management among adult diabetic patients in an urban safety net population by providing between-visit reminders and chronic disease support through cell phone text messaging. The investigators hypothesize that diabetic patients enrolled in the program will be less likely to miss scheduled appointments and will have greater perceived self-efficacy and improved patient satisfaction concerning chronic disease management. No-show rates among patients enrolled in the program are expected to be lower than among patients receiving standard care.
Interventions
BEHAVIORALPatient Relationship Management (PRM) Program
Patients will be contacted through SMS text messaging under the following circumstances: * 7 days, 2 days, and 1 day before scheduled appointments. Messages will contain the date, time, and location where the appointment is scheduled. Patients will be prompted to respond with 'YES' if they are able to keep their appointment, and 'NO' if they need to reschedule. An acknowledgement of receipt will be sent in response to all patient-initiated messages. * 3 days per week to request that patients respond with fasting blood sugar measurements. An acknowledgement of receipt will be sent in response to all patient-initiated messages.
Sponsors
Microsoft Corporation
EMC Consulting
Denver Health and Hospital Authority
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 76 Years
Healthy volunteers
No
Inclusion criteria
* patients with diabetes * receive care at a primary care clinic in the DH system * between 18 and 76 years of age * primary language of English or Spanish * ownership of a qualifying cell phone (SMS text capable) * ownership of a glucometer.
Exclusion criteria
* life expectancy less than six months, * do not have or cannot use a phone or glucometer * do not want to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient Engagement | 3 months | Patient engagement was assessed by patient text message response rates and average response times. Response rates were calculated as a percentage from the number of patient-initiated text messages sent in response to a system-generated request for information (the numerator) divided by the total number of system-generated requests for information (the denominator). Average response times were calculated from system-recorded time stamps for outbound requests sent and inbound patient-initiated responses received. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Appointment Attendance | 3 months | As measured by no-show rates for appointments at all clinics during the study period, compared between intervention and control groups |
| Perceived Self-efficacy | 3 months | As measured by comparison of patient responses to validated assessment instrument administered at baseline and post-intervention |
| Glycemic Control | 3 months | Measured by patients' self-reported fasting blood glucose levels during the intervention period and compared to previous laboratory data in the medical record. |
Countries
United States
Participant flow
Recruitment details
English and Spanish-speaking adult patients (18-76 years old) with diabetes in possession of cell phones who receive primary care at Sam Sandos Westside Family Health Center (Westside), a federally qualified community health center in the Denver Health integrated healthcare system in Denver, CO.
Pre-assignment details
Exclusion criteria included a life expectancy less than six months, age \< 18 or \> 76, and either lacking possession of or inability to use a cell phone or glucometer.
Participants by arm
| Arm | Count |
|---|---|
| Text Intervention Group of study participants who received the text message intervention over a 3-month period. | 47 |
| Total | 47 |
Baseline characteristics
| Characteristic | Text Intervention |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 3 Participants |
| Age, Categorical Between 18 and 65 years | 44 Participants |
| Age, Continuous | 50.29 years STANDARD_DEVIATION 11.24 |
| Region of Enrollment United States | 47 participants |
| Sex: Female, Male Female | 30 Participants |
| Sex: Female, Male Male | 17 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 47 |
| serious Total, serious adverse events | 0 / 47 |
Outcome results
Primary
Patient Engagement
Patient engagement was assessed by patient text message response rates and average response times. Response rates were calculated as a percentage from the number of patient-initiated text messages sent in response to a system-generated request for information (the numerator) divided by the total number of system-generated requests for information (the denominator). Average response times were calculated from system-recorded time stamps for outbound requests sent and inbound patient-initiated responses received.
Time frame: 3 months
Population: Group of study participants who received the text message intervention over a 3-month period.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Text Intervention | Patient Engagement | 68.14 text message response rate (percent) |
Secondary
Appointment Attendance
As measured by no-show rates for appointments at all clinics during the study period, compared between intervention and control groups
Time frame: 3 months
Secondary
Glycemic Control
Measured by patients' self-reported fasting blood glucose levels during the intervention period and compared to previous laboratory data in the medical record.
Time frame: 3 months
Secondary
Perceived Self-efficacy
As measured by comparison of patient responses to validated assessment instrument administered at baseline and post-intervention
Time frame: 3 months