Web-based care management in patients with poorly controlled diabetes

• HIT Description: Patient decision support / consumer health informatics / decision support-clinical guidelines More info...
  
• Purpose of Study: assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes
  
• Years of study: 2001-2003
  
• Study Design: RCT
  
• Outcomes: impact on healthcare effectiveness and quality
  

• Settings: Veteran patients with poorly controlled diabetes who had a VA Boston Healthcare System primary care provider and access to a telephone
• Intervention: participants attended a screening visit and were randomized to web-based care versus usual care. Web-based care patients continued with their Òusual careÓ but also received a notebook computer with free dial-up internet access, a glucose meter, a blood pressure monitor and access to the MyCareTeam website which was monitored by a care manager. An advanced practice nurse/certified diabetes educator provided recommendations to primary care providers and participants based on treatment algorithms.
• Evaluation Method: A1c and blood pressure measurements obtained at baseline, 3, 6, 9 and 12 months
• Description: MyCareTeam allowed participants to interact using coded identifers and access used secure socket layer encryption via a secure protocol. It accepted uploads from blood pressure and glucose monitoring devices; and, had an internal messaging system.
• Strategy: No specific strategy but use by participants was monitored over time
• Facilitators: study provided computers and internet access to participants
• Quality of Care and Patient Safety Outcome: Greater decline in A1c over time for the web-based group (-1.6 +/- 1.4%) compared to usual care (-1.2 +/- 1.4%). Persistent users had greater declines (-1.9 +/- 1.2%) compared to intermittent users (-1.2 +/- 1.4%) or usual care. Hypertensive patients in the web-based group had greater decline in systolic BP (-10 +/- 17 mmHg) than usual care (-7 +/- 21 mmHg)