Diabetes Care Challenges Offer Hospitals Strategic Opportunities

Joe Cantlupe, for HealthLeaders Media , February 19, 2014

Motivation: It's not easy to get patients to make lifestyle changes, such as increasing physical activity—what Beatty calls a "limiting step." To help, OSU provides patients with pedometers and instructs them on how to track their daily steps. "This gives us and the patient an objective number of how active the patient is and allows us to make measurable goals to improve activity," she says. "This also helps patients to see that when we discuss physical activity, any activity is good; it doesn't have to be lifting weights or jogging 3 miles a day."

Diet and nutrition: OSU educates patients about basic nutrients, especially carbohydrates. Diet and nutrition are among the "hardest components to overcome" for patients trying to control their diabetes. Among other things, the team teaches portion control and how to make healthier choices in meals, and provides cookbooks designed for diabetes patients.

Follow-up care: Proper follow-up is among the measures physicians and hospitals can take that have the "biggest impact on adherence," Beatty says. "In the office, many patients commit to making a change, but once they are home, it is easy to say, 'I'll start my exercise tomorrow.' " At OSU, the physician office contacts patients between visits and "holds them accountable to making a lifestyle change," Beatty says. "A call coming from a physician's office carries a lot of weight to patients in showing that we care and we want to help them get better. There are some patients we call every week to keep them on the path toward better health."

Success key No. 4: Text reminders

For many people, getting text messages consistently from someone may be annoying. But Sanjay Arora, MD, of the Keck School of Medicine at the University of Southern California in Los Angeles, found something else among diabetic patients treated in emergency departments. Not only did the patients like receiving the daily text messages he and his team sent as reminders to improve their control of diabetes and medication adherence but the patients also did a better job of improving their health.

Arora is an emergency department physician at the 600-bed Los Angeles County Hospital of the University of Southern California Medical Center. Patients overwhelmingly liked the messages, in part because they felt the physicians cared about them, Arora says.

The messages were simple and to the point: "Having diabetes can lead to a heart attack or stroke—but it doesn't have to" and "Eat more fruits, vegetables, beans, and whole grains, and less salt and fat."

The patients who received text messages for six months improved enough to reduce their dependence on the emergency department in their care for diabetes, Arora says. He and colleagues wrote about their findings in the Annals of Emergency Medicine. The study was dubbed "TExT-MED."

Text messaging is effective, low-cost, and widely available for patients who often see themselves as having no other source of medical care than the ED, he says.

The study focused on adult patients with poorly controlled diabetes who visited an urban, public emergency department. They received two daily text messages for 6 months. For patients who received text messages, blood glucose levels decreased by 1.05%, compared with a decrease of 0.60% in the control group. Self-reported medication adherence improved from 4.5 to 5.4 on an 8-point scale, compared with a net decrease of 0.1 points in the control group.

"The study population has very little access to regular primary care and very limited time, and they weren't getting the education they needed or the personalized level of care," he says.

The proportion of patients who visited the emergency department over the 6-month period was lower among the text-messaging group, 35.9%, than in the control group, 51.6%.

Arora says if someone sent him a text message two or three times a day, "I would think, 'Enough.' " But the patients felt different. To them, it "wasn't annoying; it felt like the first time a doctor really cared for them. That was the most surprising for me."

Reprint HLR0214-9

This article appears in the January/February 2014 issue of HealthLeaders magazine.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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1 comments on "Diabetes Care Challenges Offer Strategic Opportunities"

Neal Kaufman (2/19/2014 at 11:13 AM)
This is a comprehensive review of ways that healthcare providers can improve outcomes for patients with diabetes. I would add that hospital should consider how to impact large numbers of people in an affordable way using HIT. Large scale population health approaches which are successful at an affordable cost are emerging. These approaches help individuals take control of their unhealthy behaviors so they are able to manage their risks and their chronic conditions. The challenge is to: Provide enough consumer engagement in an effective and targeted long-term intervention; Provide support at a cost that delivers a good and early return on investment without providing an undue burden on staff or on the individual. The most successful approaches are longitudinal interventions based on what is known to impact behaviors and self-management skills of the targeted population. Successful interventions are long-term, individualized, rich in content, and help participants set goals, monitor their performance, receive and provide social support, and find needed help from peers and coaches. Modern interventions capitalize on the power of information technology to provide cost effective interventions to large numbers of individuals by automating some or most of a patient's experiences to lower the cost, while maintaining fidelity to the proven approach. At DPS Health, we help our partners create a customized recruitment campaign and support service, which when coupled with our year-long, online transformation of the NIH's Diabetes Prevention Program, show clinically significant weight loss and positive ROI. Neal Kaufman, MD,MPH nkaufman@dpshealth.com www.DPSHealth.com




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