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Exploring the Use of
Personal Health Recordsin
Diabetes ManagementA Pilot Study
Linda Wells Freiberger, FNP-C, MSN
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Acknowledgments
The project described was supported by 1 U56 AE000012-01 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.
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Contextual BackgroundJUBILEE 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
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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.
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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)
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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
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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
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FINAL FINDINGS
A1c Improved
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
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Patient Portal
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PHR Member Summary
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Data Sharing
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PHR Glucose Log
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Immediate FeedbackNormal Glucose Message High Glucose Message
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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: 370 110-120
mg/dl
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Benefits of Engagement
“I stopped eating bags of candy at one time.” K. P.
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K.C. The Super Engaged Patient11/11
•A1c= 12.24/12
•A1c = 8.28/12
•A1c = 6.2
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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
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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
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COST EXERCISE
$20,000 Estimated cost 1 patient MI with stent
$1,840,000Estimated cost of treatment 1 uninsured patient
per county in Indiana
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Burden of Poor Engagement and Poor Self Care Management
E. C. Suffered amputation of a toe– Estimated total cost $11,271
• Physician $876.00• Hospital 9880.00 (~1800.00 per day)• Anesthesia 515.00 (1 hour, 15 minutes)
(http://www.healthcarebluebook.com)
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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