A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus
- Steven Shea,
- Ruth S Weinstock,
- Justin Starren,
- Jeanne Teresi,
- Walter Palmas,
- Lesley Field,
- Philip Morin,
- Robin Goland,
- Roberto E Izquierdo,
- L Thomas Wolff,
- Mohammed Ashraf,
- Charlyn Hilliman,
- Stephanie Silver,
- Suzanne Meyer,
- Douglas Holmes,
- Eva Petkova,
- Linnea Capps,
- Rafael A Lantigua for the IDEATel Consortium
- Affiliations of the authors: Departments of Medicine (SSh, WP, LF, RG, RAL), Biomedical Informatics (SSh, JS, MA, CH), and Radiology (JS) and Naomi Berrie Diabetes Center (RG), Columbia University, New York, NY; Departments of Epidemiology (SSh) and Biostatistics (EP), Joseph Mailman School of Public Health, Columbia University, New York, NY; Joslin Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY (RSW, REI, SM); Department of Veterans Affairs, VA Medical Center, Syracuse, NY (RSW); Research Division of the Hebrew Home for the Aged at Riverdale, Bronx, NY (JT, SSi, DH); Stroud Center, Columbia University, and New York State Psychiatric Institute, New York, NY (JT); Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY (LTW); Department of Medicine, Harlem Hospital Center, New York, NY (LC)
- Correspondence and reprints: Steven Shea, MD, Division of General Medicine, 630 W. 168th Street, New York, NY 10032; e-mail: <ss35{at}columbia.edu>
- Received 22 July 2005
- Accepted 21 September 2005
Abstract
Background Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness.
Methods The authors conducted a randomized, controlled trial comparing telemedicine case management to usual care, with blinding of those obtaining outcome data, in 1,665 Medicare recipients with diabetes, aged 55 years or greater, and living in federally designated medically underserved areas of New York State. The primary endpoints were HgbA1c, blood pressure, and low-density lipoprotein (LDL) cholesterol levels.
Results In the intervention group (n = 844), mean HgbA1c improved over one year from 7.35% to 6.97% and from 8.35% to 7.42% in the subgroup with baseline HgbA1c ≥7% (n = 353). In the usual care group (n = 821) mean HgbA1c improved over one year from 7.42% to 7.17%. Adjusted net reductions (one-year minus baseline mean values in each group, compared between groups) favoring the intervention were as follows: HgbA1c, 0.18% (p = 0.006), systolic and diastolic blood pressure, 3.4 (p = 0.001) and 1.9 mm Hg (p < 0.001), and LDL cholesterol, 9.5 mg/dL (p < 0.001). In the subgroup with baseline HgbA1c ≥7%, net adjusted reduction in HgbA1c favoring the intervention group was 0.32% (p = 0.002). Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dL. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York.
Conclusion Telemedicine case management improved glycemic control, blood pressure levels, and total and LDL cholesterol levels at one year of follow-up.
Footnotes
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Supported by Cooperative Agreement 95-C-90998 from the Centers for Medicare and Medicaid Services.
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We acknowledge the contributions of Dr. Paul D. Clayton to the conceptualization of this project and to the creation of the clinical medical informatics infrastructure at Columbia University Medical Center and of Drs. Edward Shortliffe and George Hripcsak in providing support for that infrastructure. This paper is dedicated to the memory of Catherine Tuck, MD.
The IDEATel Research Consortium includes the following: Columbia University and New York-Presbyterian Hospital (New York, NY): Steven Shea, MD, MS, Justin Starren, MSD, PhD, Walter Palmas, MD, Lesley Field, RN, MSN, Robin Goland, MD, Catherine Tuck, MD (deceased), Rafael Lantigua, MD, Soumitra Sengupta, PhD, David Kaufman, PhD, Vimla Patel, PhD, Mohammed Ashraf, Charlyn Hilliman, MPA, Sean Mota, Patricia Kringas, RN, Jessica Rivera, RN, Rene Bachmann, RN, CDN, CDE, David Baorto, MD, PhD, Dimitri Borovtsov, Yao Huang, Rajhunathan Kamasmudram, PhD, Khalid Qureshi, Yuri Vayman; Harlem Hospital Center (New York, NY): Linnea Capps, MD; St. Luke's-Roosevelt Hospital Center (New York, NY): Alejandro Prigollini, MD; Research Division of the Hebrew Home for the Aged at Riverdale (Bronx, NY): Douglas Holmes, PhD, Jeanne Teresi, EdD, PhD, Stephanie Silver, MPH, Jian Kong, MS, Eva Petkova, PhD, Joseph P. Eimicke, MS, Onie Manzano, BS; SUNY Upstate Medical University at Syracuse (Syracuse, NY): Ruth Weinstock, MD, PhD, Philip Morin, MS, Roberto Izquierdo, MD, L. Thomas Wolff, MD, Suzanne Meyer, RN, CDE, Paul Knudson, MD, Suzan M. Carusone, RN, CCRC, Fraser G. Tudiver, MD (currently at East Tennessee State University, Johnson City, TN), Teresa J. Wagner, MS, Carina Lagua, MA, RD, CDE, Susan Fox, RN, Susan West, RN, MSN, CDE, JoAnn Shupe, AOS, Donald R. Roller, BS, Joseph Ziemba, MBA, David P. Thomson, MD, Kelly Duncan BSW, CCRC, Sarah Doolittle, BS, CCRC, Joanne Kearns, MA, RD, CDE, Deborah Bowerman, RN, CDE, Phyllis T. Bazen, MSN, ACNP-C, Pamela Suddaby, RN, BS, Kristine M. Brindak, RN; A. L. Lee Memorial Hospital, Inc. (Fulton, NY): Shirley Seabury, MHA; Arnot-Ogden Medical Center (Elmira, NY): John F. Carroll, MD, MBA, Frederic P. Skinner, MD, PhD, Terri L. Ennis, RN. Bassett Healthcare (Cooperstown, NY): Kathleen Sellers, RN, PhD, Barbara Leo, BA, BS, RN, Elsie Haus, MEd, FNP, Catherine Cooney, BS, MA, RN; Delaware Valley Hospital (Walton, NY): Michael J. Freeman, DO, MPH; Family Health Network of Central New York, Inc. (Cortland, NY): Susan Ulrich, MS, RN, CPNP; Guthrie Healthcare System (Sayre, PA): Brian D. Cassetta, MD; Hudson Headwaters Health Network (Glens Falls, NY): Patricia Auer, MSN, FNP, W. Emily Hammond, AAS, RN, Cairenn L. Young, MSW, Mary M. Beadnell, LPN; Lourdes Hospital (Binghamton, NY): Timothy C. Howland, MD; Olean General Hospital (Olean, NY): Robert Catalano, MD, Galvin Anderson, MD, Terri N. Kolasinski, RN; Samaritan Medical Center (Watertown, NY): Anil Shah, MD, Kate R. Fraczek, RN, Terry Flynt, BSN, RN; State University of New York at Buffalo (Buffalo, NY): John Taylor, MBA, Lurene R. Tumiel, PhD, Marc Shilling, MA, MPA, Chester Fox, MD; United Health Services (Binghamton, NY): David Kwiatkowski, MD; American Telecare, Inc. (Eden Prairie, MN): Randall S. Moore, MD, MBA, C. R. Abbruscato, MSEE, Karen Boril.
