Achieving Value-Based Care in Chronic Disease Management: Intervention Study

Abstract

Background The World Health Organization notes that diabetes, a chronic disease, is a silent epidemic, and by 2020 there will be a 54% rise in the total number of individuals diagnosed with this disease. These are alarming figures that have significant repercussions for the quality of life of individuals and their families as well as for the financial stress of health care systems globally. Early detection and proactive management of diabetes is essential. The Diamond solution provides diabetes self-management by enabling patients to send details about their blood sugar readings at specific times to their nominated care coordinator to receive recommendations for diet and exercise and insulin titration. Objective The aim of the study was to assess the usability, acceptability, and fidelity of the Diamond diabetes monitoring device for patients with gestational diabetes mellitus (GDM). Specifically assessed were (1) patient compliance, (2) patient satisfaction, (3) level of glycemic control achieved, and (4) health professional satisfaction. Methods Using a design science research perspective, the Diamond diabetes monitoring device solution was adapted to the Australian health care environment. Once the solution was deemed fit for purpose by the director of the OB/GYN clinical institute and on securing all relevant ethics approvals, a 2-period 2-arm nonblinded crossover clinical trial was conducted for 8 weeks total time with crossover at 4 weeks to establish proof of concept, usability, and fidelity. The patient perspective was assessed by using structured questionnaires at 4 specific stages of the project, while the clinician perspective was captured via semistructured interviews and unstructured questionnaires. Results The 10 patients studied reported preferring standard care with the technology solution to standard care alone. Further, all clinicians involved concurred that the technology solution greatly assisted their ability to provide higher value patient-centered care. They also noted that it was extremely helpful for assisting in systematically monitoring glucose levels and any/all changes and trends. Conclusions Based on these initial findings, we offer a holistic pervasive approach to enable the achievement of value-based, patient-centered care in chronic disease management. Key lessons include the importance when designing such solutions to focus on the two primary user groups (patients and clinicians).

Essential Considerations for Successful Consumer Health Informatics Solutions

“…Many elements that are typically considered separately are important to keep in mind when examining the domain of CHI. In particular, the rise of chronic diseases such as diabetes, the notion of power-knowledge, and the move to value-based care 6 .…”

“…Today chronic diseases such as asthma, cancer, various cardiac conditions, diabetes, mental health issues, and obesity have replaced infectious diseases as one of the top global causes of deaths and morbidity 6 , 7 . A critical aspect of these chronic diseases is that, in general, there is no immediate cure and the affected individuals typically must continue to live their life and manage their condition.…”

“…Diabetes is one of the five major chronic diseases and has been termed by the WHO as the silent epidemic 6 7 8 . By definition, for most sufferers of diabetes (or other chronic diseases) there is no likely cure which makes prudent management of their condition key to living a quality life 6 .…”

“…Diabetes is one of the five major chronic diseases and has been termed by the WHO as the silent epidemic 6 7 8 . By definition, for most sufferers of diabetes (or other chronic diseases) there is no likely cure which makes prudent management of their condition key to living a quality life 6 . Good management is predicated on pertinent information and germane knowledge 5 , which at times is not always easy for these patients to access and/ or acquire.…”

“…Arguably, one of the key areas for facilitating and supporting superior self-management is for patients suffering from diabetes: a chronic disease that if not managed can lead to far reaching and unpleasant complications 2 , 5 , 6 . Self-management is not only important as it empowers diabetes patients while acknowledging their central role and responsibility for managing their healthcare 3 but the active participation of diabetes patients in self-management is a key and recognised strategy for managing their condition and reaching improved treatment outcomes 3 4 5 6 . As Wickramasinghe and Goldberg 2 have noted, technology, most especially a pervasive wireless technology solution, is an excellent tool for supporting and enabling patient participation anytime, anywhere.…”