Determining the Effect on Patients of Internet-Based Diabetes Disease Management
Condition: Diabetes Mellitus, Type 2
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      This grant supports a 12-month randomized controlled trial comparing usual care versus
      collaborative disease management over the Internet among disadvantaged African-Americans with
      Type 2 diabetes. The project aims to: (1) determine the effect of case-managed, Web-based
      diabetes care on glycemic control, health care utilization, self-efficacy, and patient
      satisfaction; and (2) qualitatively identify enablers of the successful use of computers, the
      Internet, and e-Health applications by disadvantaged patients.
    

Detailed description: 
      We propose to conduct a 12-month randomized controlled trial comparing usual care versus
      chronic disease management over the Internet among disadvantaged African-Americans with type
      2 diabetes. Subjects will be recruited from patients receiving primary care at Harborview
      Medical Center, the County facility administered by the University of Washington in Seattle.
      As part of a pretest-posttest experimental design, 30 intervention subjects will be trained
      to use an existing diabetes disease-management module comprising six Web sites that are
      accessed from home via links displayed within the University's "MyUW" Internet portal. These
      sites allow patients to:

        1. View their entire electronic medical record, the same record used by providers,

        2. Upload blood glucose readings stored in a digital meter,

        3. Enter medication, nutrition, and exercise information into an online daily diary,

        4. Communicate with providers regarding treatment recommendations or other questions using
           clinical e-mail,

        5. Obtain additional information from a traditional patient education site with endorsed
           content, and

        6. Employ a second education site to collaboratively generate action plans intended to
           enhance self-efficacy.

      All data can be viewed by patients and providers in online trended displays that a clinical
      pharmacist will use to review cases no less often than weekly. As an attention control, 30
      subjects will also be trained to use a provided personal computer to access Internet
      knowledge resources, but will not have access to the case-management services and module
      being evaluated. By comparing the two groups, we aim to:

        1. Determine the effect of case-managed, Web-based diabetes care on glycemic control,
           healthcare utilization, self-efficacy, and patient satisfaction, and

        2. Use semi-structured interviews among a subsample of both trial arms to qualitatively
           identify enablers of the successful use of computers, the Internet, and e-health
           applications by disadvantaged patients.
    

Intervention name(s): Internet co-management module
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Diabetes; Health Education; Information Technology; African Americans; Disease Management; Internet; Patient Education