exploring the use of personal health records in diabetes management a pilot study linda wells...

Exploring the Use of

Personal Health Recordsin

Diabetes ManagementA Pilot Study

Linda Wells Freiberger, FNP-C, MSN

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.

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

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

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

Patient Portal

PHR Member Summary

Data Sharing

PHR Glucose Log

Immediate FeedbackNormal 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: 370 110-120

mg/dl

Benefits of Engagement

“I stopped eating bags of candy at one time.” K. P.

K.C. The Super Engaged Patient11/11

•A1c= 12.24/12

•A1c = 8.28/12

•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

$1,840,000Estimated 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 $876.00• Hospital 9880.00 (~1800.00 per day)• Anesthesia 515.00 (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

THANK YOU!!

Lwells-freib@iuhealth.orgLindawells-feib@healthlinc.org