Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis

Abstract

Background Diabetes outcomes are influenced by host factors, settings, and care processes. We examined the association of data-driven integrated care assisted by information and communications technology (ICT) with clinical outcomes in type 2 diabetes in public and private healthcare settings. Methods and findings The web-based Joint Asia Diabetes Evaluation (JADE) platform provides a protocol to guide data collection for issuing a personalized JADE report including risk categories (1-4, lowhigh), 5-year probabilities of cardiovascular-renal events, and trends and targets of 4 risk factors with tailored decision support. The JADE program is a prospective cohort study implemented in a naturalistic environment where patients underwent nurse-led structured

Effect of a Web-Based Management Guide on Risk Factors in Patients With Type 2 Diabetes and Diabetic Kidney Disease

“…Given the efficacy of multicomponent integrated care, 15 self-management, 33 and use of organ-protective drugs in clinical trial settings, 35 the results of this RCT have provided an implementation prototype to payers, policy makers, and health care practitioners for translating evidence to practice. 36 , 37 …”

Effects of a Technology-Assisted Integrated Diabetes Care Program on Cardiometabolic Risk Factors Among Patients With Type 2 Diabetes in the Asia-Pacific Region

“… 28 In Hong Kong, after a median follow-up of 4.5 to 6.0 years, the implementation of a similar risk assessment and management program complemented by a patient empowerment program in primary and secondary care settings was associated with a 30% to 60% reduction in the risk of cardiovascular-kidney events and death. 17 , 29 In previous randomized clinical trials (such as the Intensified Multifactorial Intervention in Patients With Type 2 Diabetes and Microalbuminuria [Steno-2] study, the Japan Diabetes Optimal Integrated Treatment Study for 3 Major Risk Factors of Cardiovascular Diseases [J-DOIT3], and the SURE study, which were characterized by the use of protocols, care coordinators, standardized data collection, and access to essential medications), marked improvement in clinical outcomes was observed, even among participants in the control groups. 7 , 23 , 30 In the present study, by training nurses to perform the JADE technology–guided structured evaluations, we observed reductions in multiple risk factors after 12 months, supporting the notion that the provision of structured care using information and communications technology and nonphysician personnel can facilitate systematic data collection to change actions in care delivery.…”

“…The JADE technology consists of a web-based portal that contains templates for guiding structured evaluation workflow, clinical decision support, and evidence-based care protocol. 9 , 17 The JADE portal facilitates the structured collection of clinical and biochemical data to stratify patients into 1 of 4 distinct risk categories (from low risk to very high risk) for estimating cardiovascular-kidney events and all-cause mortality. 9 The JADE report (eFigure 1 in Supplement 2 ) displays the 5-year probability of first cardiovascular-kidney events and patterns or targets of risk factors, with tailored recommendations for patients (eg, self-management skills and treatment adherence) and health care professionals (eg, treatment intensification, referral for education, and follow-up schedule).…”

“… 17 The data formed the basis of clinic-based registers for quality assurance and were used to issue the JADE personalized reports with the aim of empowering patients and promoting shared decision-making. 17 …”

[The Multidisciplinary Management of Type 2 Diabetes: an Integrated Care Model]

“…Lim e colleghi [33] hanno condotto un'analisi di coorte retrospettiva per valutare gli esiti dell'implementazione di un programma di cura integrata applicato a più di 16.000 pazienti con diabete di tipo 2 a Hong Kong. Tale programma era gestito da infermieri e si applicava sia al settore sanitario pubblico sia a quello privato.…”