The purpose of this study is to improve the quality of VA diabetes care using an automated telephone disease management (ATDM) system that administers patient assessments and targeted self-care education between clinic visits.
In this ongoing study, we are determining: 1) the reliability and validity of Automated Telephone Disease Management (ATDM) assessments of patients' glycemic control, health-related quality of life (HRQL), self-care, and satisfaction with care; 2) the extent to which these assessments identify patients at risk for poor outcomes; and 3) the cost-effectiveness of an intervention in which ATDM assessment reports are provided regularly to patients' primary care providers.
We are refining and expanding previously-developed ATDM assessment instruments by incorporating measures of patient-centered outcomes. We are enrolling 450 patients from VISN 12 and VISN 21. Patients receive weekly ATDM assessments for six months. Other data on their health status and service use are being collected from medical records, laboratory tests, telephone surveys, and Austin Automation Center files. After determining the concurrent reliability, validity, and prognostic significance of the ATDM assessments, we will examine variation in ATDM-reported outcomes across Networks, facilities, and patient groups. In the second phase of the study, we will conduct an effectiveness trial with a one year follow up period. We will use the findings from our process evaluation to modify the ATDM assessments and design provider feedback reports. We will enroll 240 patients from the two Networks (i.e., 480 patients overall). Patients will be assigned to experimental or usual care control groups using a combination of randomization and cutoff-based assignment. We will measure the intervention's impact on patients' glycemic control, symptoms, self-care, and patient-centered outcomes. We will use VA costing database and Medicare claims files to evaluate cost-effectiveness.
Data from patients' baseline surveys have identified a variety of doctor-patient communication styles associated with better adherence to self-care regimens and improved health outcomes. VA patients’ were much less likely to forego medication due to cost pressures than patients with any other insurance type. Participants have completed roughly 5,000 automated telephone assessments out of about 20,000 individual calling attempts. ATDM reports of functioning and treatment satisfaction are reliable and valid.
The model of automated telephone assessments developed and evaluated in this study could be a cost-effective means of improving clinical decision-making and diabetes treatment outcomes. The study is identifying clinic and provider factors that facilitate effective implementation in VA. Large-scale implementation of this intervention could save treatment costs, improve patients' access to care, and improve providers' adherence to treatment guidelines.
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Diabetes, Education (patient), Telemedicine