Presentation on theme: "Exploring the Use of Personal Health Records in Diabetes Management A Pilot Study Linda Wells Freiberger, FNP-C, MSN."— Presentation transcript:
Exploring the Use of Personal Health Records in Diabetes Management A Pilot Study Linda Wells Freiberger, FNP-C, MSN
Acknowledgments The project described was supported by 1 U56 AE from the Department of Health and Human Services. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health and Human Services.
Contextual Background JUBILEE COMMUNITY HEALTH A nonprofit (501c3) health clinic established in 1999 in Paoli, Indiana Mission: To provide low fee-for-service primary care to uninsured populations Partially supported through IU Health-Paoli and local community grants Self-pay population for health care
Diabetes Costs Estimated costs associated with diabetes as of 2007(NIH, 2011) Direct Medical Costs $116 billion—after adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes Indirect Costs $58 billion-disability, work loss, premature mortality. Total Costs$174 billion, medical related expenses are twice as high in people with diabetes than those without.
Diabetes Diabetes is a serious, costly and preventable chronic disease in the US. –As of 2010, 25.8 million(8.3%) have been affected in the US (NIH, 2011). –In 2011, 10.1% of Indiana adults reported having some form of diabetes(ISDH, 2012). –Racial/Ethnic and socioeconomically disadvantaged groups experience the steepest increases and the most substantial effects from diabetes (Beckles et al, 2011)
Study Goal and Objectives Goal –To explore the use of a PHR by rural, uninsured patients with diabetes Objectives –Texting and PHR use to improve glucose outcomes –Shared care between clinician and patient using PHR Methodology –Use of a convenience sample (N=28) –Pre/Post Variables Examined A1c Glucose levels
Results Early findings – –most were attempting use within 1 month –After 6 months 35.7% were actively engaging in PHR use and recording glucose readings
FINAL FINDINGS Glucose Controlled No Glucose Improvement 28.6% 21.4% 21.4% *N= 28 with 50% drop out *Calculations based on participants who completed the study
PHR Member Summary
PHR Glucose Log
Immediate Feedback Normal Glucose Message High Glucose Message
Benefits of Engagement H. H. –“Oh, I will just go to the library and enter my sugar readings.” –Home PC failed during the study –Unable to afford A1c levels –Continued testing and entering glucose levels in PHR –Improved glucose: mg/dl
Benefits of Engagement “I stopped eating bags of candy at one time.” K. P.
K.C. The Super Engaged Patient 11/11 A1c= /12 A1c = 8.2 8/12 A1c = 6.2
ED VISITS & ADMISSIONS 6 Months Prior 1 ED visit 1 Admission 6 Months Post 7 ED visits –Trauma x 2 –Chest pain x 2, MI x 1 –Abdominal mass –Extended psych med/suicidal ideation 4 Admissions
Burden of Poor Engagement and Inadequate Self-care Management S. B. Suffered Acute MI with stent placement in September 2012 –Estimated cost stent $12,978 –Estimated hospitalization cost $5,151 –Estimated ED visit charges $334 *Estimated Direct Variable Costs = $18,463
COST EXERCISE $20,000 Estimated cost 1 patient MI with stent $1,840,000 Estimated cost of treatment 1 uninsured patient per county in Indiana
Burden of Poor Engagement and Poor Self Care Management E. C. Suffered amputation of a toe –Estimated total cost $11,271 Physician $ Hospital (~ per day) Anesthesia (1 hour, 15 minutes) (http://www.healthcarebluebook.com)
Outcomes Enhanced patient – clinician engagement Potential to improve clinical outcomes of patients with diabetes Uninsured populations can use Health Information Technology (HIT) tools to improve self-care management of chronic disease Potential to reduce health care costs