The U.S. Department of Health and Human Services’ (HHS) Office of Minority Health, the American Association of Diabetes Educators (AADE), and AT&T recently announced a first-of-its-kind initiative to evaluate the use of mobile devices to deliver Diabetes Self-Management Training (DSMT) within an underserved minority community in Dallas, Texas.
DSMT is a collaborative process through which people with or at risk for diabetes gain the knowledge and skills needed to modify behavior and self-manage the disease and its related chronic conditions. The initiative, which began planning in early 2011, is intended to measure the effectiveness of evidence-based DSMT interventions delivered to participants by diabetes educators using mobile health (mHealth) programming.
Nearly 26 million Americans have diabetes, and racial and ethnic minorities continue to have higher rates of diabetes after adjusting for population age differences, according to the Centers for Disease Control and Prevention. African Americans, particularly inner-city residents, are likely to be medically underserved, without access to constant provider monitoring.
AT&T (Dallas) will contribute $100,000 to the AADE to fund the study and provide approximately 150 smartphones with voice and data plans for the patients, diabetes educators, and other education personnel; however, the exact smartphone has yet to be selected. The diabetes educators will deliver DSMT to patients using a video application on the mobile devices. DSMT must be prescribed by a Medicare beneficiary’s healthcare provider in order to be eligible for Medicare reimbursement.
Currently, AADE is reviewing a memo of understanding, which maps out the roles and responsibilities of all parties involved. The study will be over an eight-month period, with patient goals being assessed on an individual basis to determine what education is needed. The initiative should start later this year, with AADE finalizing the curriculum in the first month and enrolling patients with the help of the Dallas-based Diabetes Health and Wellness Institute, an accredited DSMT program and an affiliate of Baylor Health Care System and Baylor University Medical Center at Dallas. Implementation will begin in the second month and continue through the seventh month, with the eighth month serving as a wrap-up.
Dallas was chosen as the study’s base as it has a high level of underserved minority population. “Our position is that this [training] is needed for patients in urban areas who live at one end and have to go to a provider at the other end of the city,” says Lana Vukovljak, CEO, AADE, “and usually don’t because there is a transportation issue or a time issue, or a number of different issues these patients face.”
Once complete, the AADE will evaluate the project, with support from the Office of Minority Health using a variety of project metrics like patient self care and behavior change over time, as well as clinical outcomes like blood pressure, BMI, and A1C levels; satisfaction evaluations by clinicians and patients; and any decreases in preventable healthcare utilization.
The results from this study have the possibility of influencing how diabetes training is embedded into hospital protocol. Garth N. Graham, M.D., deputy assistant secretary for minority health, HHS, says it’s first important to understand how diabetics utilize technology for their care. “Hospitals, healthcare systems, and the federal government need to understand it’s about learning how this technology changes behavior,” he says, “and how does it change behavior in a positive way in terms of health outcomes and whether the frequency and the types of communication used make a difference.”
As Vukovljak says, diabetes is a complex disease to manage and patients need lots of support along the way to improve outcomes. “It’s always a challenge to keep people in the program,” she says. “Hence this whole idea is to make it easier for people to receive this support and education and care where they live and work, instead of them coming back to a healthcare provider for everything they need.”
Other challenges are the communities themselves that face health disparities, says Graham. “An uncertainty, and that’s why were doing the study, is to prove that the kind of activities in terms of utilization of technology is more efficient and effective, and that it is more beneficial for diabetic teaching—that’s what we hope to prove,” says Graham. “It’s a challenge to be able to show that in a productive way.”
Even though HHS has been involved with pilots involving activities around employing EHRs in minority communities with high disease burdens, the DSMT program is the first of its kind to employ diabetes video training via smartphones. HHS is involved in other mobile projects like its much-publicized text4baby program that sends text-length health information and resources timed to the baby’s due date.
Possible further extensions of the DSMT program include integrating patient information into EHRs and expanding the technology to other disease states like heart failure and coronary artery disease, but it was unclear what the future breadth of the project.