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    An mHealth diabetes intervention for glucose control: Health care utilization analysis

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    Author
    Quinn, C.C.
    Swasey, K.K.
    Torain, J.M.
    Date
    2018
    Journal
    Journal of Medical Internet Research
    Publisher
    Journal of Medical Internet Research
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.2196/10776
    Abstract
    Background: Type 2 diabetes (T2D) is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health (mHealth) is a promising tool to encourage self-management, but few studies have investigated the impact of mHealth on health care utilization. Objective: The objective of this analysis was to determine the change in 2-year health service utilization and whether utilization explained a 1.9% absolute decrease in glycated hemoglobin (HbA1c) over 1-year in the Mobile Diabetes Intervention Study (MDIS). Methods: We used commercial claims data from 2006 to 2010 linked to enrolled patients' medical chart data in 26 primary care practices in Maryland, USA. Secondary claims data analyses were available for 56% (92/163) of participants. In the primary MDIS study, physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions. Patients followed physician randomization assignment. The main variables in the analysis included health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in 2-year health service usage, comparing rates of usage pre- and posttrial. We also examined whether utilization explained the 1.9% decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial. Results: A significant group by time effect was observed in physician office visits, general practitioner visits, other outpatient services, prescription medications, and podiatrist visits. Physician office visits (P=.01) and general practitioner visits (P=.02) both decreased for all intervention groups during the study period, whereas prescription claims (P<.001) increased. The frequency of other outpatient services (P=.001) and podiatrist visits (P=.04) decreased for the control group and Least complex intervention group but increased for the 2 most complex intervention groups. No significant effects of utilization were observed to explain the clinically significant change in HbA1c. Conclusions: Claims data analyses identified patterns of utilization relevant to mHealth interventions. Findings may encourage patients and health providers to discuss the utilization of treatment-recommended services, lab tests, and prescribed medications. Copyright Charlene C Quinn, Krystal K Swasey, Jamila M Torain, Michelle D Shardell, Michael L Terrin, Erik A Barr, Ann L Gruber-Baldini.
    Sponsors
    This research project was funded through a contract between the University of Maryland, Baltimore, and WellDoc, in addition to contributions by CareFirst BlueCross BlueShield of Maryland, LifeScan, and Sprint. Additional funding was provided by the Maryland Industrial Partnerships program through the University of Maryland, an initiative of the A James Clark School of Engineering�s Maryland Technology Enterprise Institute.
    Keyword
    Cluster randomized clinical trial
    Health care
    Health service utilization
    MHealth
    Type 2 diabetes
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85055282858&doi=10.2196%2f10776&partnerID=40&md5=c54be328432c96cb88cc45de8e24f986; http://hdl.handle.net/10713/9212
    ae974a485f413a2113503eed53cd6c53
    10.2196/10776
    Scopus Count
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    UMB Open Access Articles 2018

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