Automated Telephone Self-Management Support for Diabetes in a Low-Income Health Plan: A Health Care Utilization and Cost Analysis

Abstract

The objective was to determine whether automated telephone self-management support (ATSM) for lowincome, linguistically diverse health plan members with diabetes affects health care utilization or cost. A government-sponsored managed care plan for low-income patients implemented a demonstration project between 2009 and 2011 that involved a 6-month ATSM intervention for 362 English-, Spanish-, or Cantonesespeaking members with diabetes from 4 publicly funded clinics. Participants were randomized to immediate intervention or a wait-list. Medical and pharmacy claims used in this analysis were obtained from the managed care plan. Medical claims included hospitalizations, ambulance use, emergency department visits, and outpatient visits. In the 6-month period following enrollment, intervention participants generated half as many emergency department visits and hospitalizations (rate ratio 0.52, 95% CI 0.26, 1.04) compared to wait-listed participants, but these differences did not reach statistical significance (P = 0.06). With adjustment for prior year cost, intervention participants also had a nonsignificant reduction of $26.78 in total health care costs compared to wait-listed individuals (P = 0.93). The observed trends suggest that ATSM could yield potential health service benefits for health plans that provide coverage for chronic disease patients in safety net settings. ATSM should be further scaled up to determine whether it is associated with a greater reduction in health care utilization and costs. (Population Health Management 2015;18:412-420)

Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

“…Studies that were included were those published since 2014, with data collected from USA (n = 11) [19][20][21][22][23][24][25][26][27][28][29], UK (n = 3) [30][31][32], Hong Kong (n = 1) [33], Denmark (n = 1) [34], Canada (n = 1) [35], Israel (n = 1) [36] and Australia (n = 1) [37]. There were a range of interventions identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine (n = 3) [20,34,37], education (n = 2) [19,30], integrated care pathways (n = 4) [23][24][25]31], enhanced primary care (n = 7) [26-29, 32, 33, 35] and care management teams (n = 3) [21,22,36]. The study design of the papers were heterogenous; 3 before-after studies [25,26,32], 1 randomised controlled trial (RCT) [37], 4 cohort studies [19,22,23,33], 2 quasi experiments [20,24], 1 cross sectional study [36], 1 mixed method study [34], 4…”

“…There were a range of interventions identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine (n = 3) [20,34,37], education (n = 2) [19,30], integrated care pathways (n = 4) [23][24][25]31], enhanced primary care (n = 7) [26-29, 32, 33, 35] and care management teams (n = 3) [21,22,36]. The study design of the papers were heterogenous; 3 before-after studies [25,26,32], 1 randomised controlled trial (RCT) [37], 4 cohort studies [19,22,23,33], 2 quasi experiments [20,24], 1 cross sectional study [36], 1 mixed method study [34], 4 [21,27,35]. The sample size of the 19 papers ranged from n = 25 to n = 104,000.…”

“…Based on the SURE guidelines, there were 7 high quality papers [20,23,25,26,32,33,37], 3 moderate quality papers [19,22,24] and 1 low quality paper [36]. It was not possible to complete a critical appraisal for 8 papers; 3 papers where the study design was not clear [21,27,35] and 5 papers where the study design did not fit the SURE guidelines (18,(26)(27)(28)31).…”

What matters when exploring fidelity when using health IT to reduce disparities?

“…Language-concordant care, delivered through patient counselling or health coaching, is a critical predictor of improved self-management outcomes [ 11 – 13 ] and can address disparities in health outcomes [ 14 , 15 ]. Technology-assisted diabetes self-management and prevention programs, including those that provide patient-centered supports, have expanded significantly in the last decade with a myriad of approaches including: web-based programs [ 16 , 17 ], SMART phone applications or apps [ 18 , 19 ], telephone-based automated call programs, (often referred to as Automated Telephonic Self-Management Support, or ‘ATSM’ or Interactive Voice Response) which blend narratives content with queries that require patients to respond via touch tone with the information going to a central location for review [ 20 – 24 ]. However, studies have noted that language-concordant intervention delivery is limited [ 25 ] highlighting a gap in using Health IT to reduce disparities in ways to ensure the digital divide is not exacerbated for low-income, limited English proficient populations.…”

What Matters When Exploring Fidelity in Interventions Using Health It to Reduce Disparities in Language-diverse Populations?”

“…Language-concordant care, delivered through patient counselling or health coaching, is a critical predictor of improved diabetes self-management outcomes [14,15,16]. Technology-assisted diabetes self-management and prevention programs, including those that provide patient-centered supports, have expanded signi cantly in the last decade with a myriad of approaches including: webbased programs [17,18], SMART phone applications or apps [19,20], telephone-based automated call programs, (often referred to as Automated Telephonic Self-Management Support, or 'ATSM' or Interactive Voice Response) which blend narratives content with queries that require patients to respond via touch tone with the information going to a central location for review [21,22,23,24,25]. Each of these program archetypes provides an e cient platform to deliver multi-lingual content, content tailored to local context, and a range of additional modular features.…”