DOI: 10.3886/icpsr34352.v1
title: Text Message Outreach for Complex Patients with Diabetes in Denver, CO, 2011-2012
title: Version 1

description: <strong>Background.</strong> Medically underserved groups are more likely to have poorly-controlled chronic illness and to experience barriers in accessing health care. Traditional chronic disease management through the 20-minute clinic visit presents significant challenges for these patients. Health information technology (HIT) can be used to help patients manage chronic conditions outside the clinic setting. Text messaging has been associated with improved glycemic control when used to assist with diabetes case management, and high rates of cell phone access are reported among groups with low rates of computer and internet use (e.g. 71 percent among African Americans and 59 percent among Hispanics/Latinos).
<strong>Population.</strong> The study was conducted among adult diabetic patients in possession of cell phones who receive regular treatment at federally qualified community health centers in Denver, CO, which serves an urban population that is predominantly either uninsured (41 percent) or on Medicaid or Medicare (56 percent). A total of 133 patients were enrolled in the feasibility study, of which 65.5 percent were Latino, 8.5 percent were Black, and 25 percent were White. The majority of patients were over age 50 (70 percent), with more women (65 percent) than men (35 percent).
<strong>mHealth Infrastructure.</strong> A software platform, the Patient Relationship Manager (PRM), was created in partnership with EMC Consulting and Microsoft Corporation (MS Customer Relationship Management software- name, version number) to send and receive text messages reminding patients of upcoming appointments and requesting patient self-reported blood sugar measurements according to an automated schedule. Platform functionality was expanded with grant funding from the Agency for Healthcare Research and Quality (AHRQ), adding support for self-reported blood pressure and step count data and automated links to clinical laboratory and pharmacy data sources to support outreach to patients overdue for laboratory tests and medication refills. The PRM system transmitted regularly-scheduled outbound text messages and processed patient-provided text message responses. Response data were transformed by PRM into standard formats, integrated into the electronic medical record, and made available to providers at the point of care. Structured, de-identified research data were incorporated into a REDCap dataset to provide access via a platform used by 380 institutions to facilitate comparative effectiveness research. Misformatted responses and home measurements outside established ranges were automatically flagged by PRM and added to a work queue for review and follow-up action by clinical personnel. A registered nurse reviewed all flagged messages, coordinated with primary care providers, and contacted patients by telephone for follow-up according to clinical guidelines.
<strong>Design and Methods.</strong> In an initial pilot study, patients (N=47) received text message prompts over a three month period. Blood sugar readings were requested 3 times per week (MWF), and appointment reminders were sent 7, 3, and 1 day(s) prior to each scheduled appointment. 
A subsequent 6-month feasibility study (N=133) offered support for patients to report up to 3 different types of home measurements (blood sugars, blood pressures, and step counts) up to 5 days per week, according to patient preferences, and automated outreach to patients late for medication refills and overdue for laboratory tests. Review of text message data gauged the accuracy of home measurement prompts and automated outreach based on laboratory and pharmacy clinical datasets.
Three focus groups were conducted among feasibility study participants in English and Spanish, with group composition purposively structured based on patients' primary language and frequency of text message response.
<strong>Data Access.</strong> These data are not available from ICPSR. The data from this study are hosted at REDCap and require the signature on a data use agreement with Denver Health. To access these data, users must complete and submit the attached data use agreement to Dr. Henry Fischer (henry.fischer@dhha.org) or Susan Moore (susan.moore@dhha.org).
Documentation files, however, including the data dictionary and the Stanford Self-Efficacy Scale, can be found on the ICPSR site.
description: None.
description: Response Rates: Patients responded to text requests and sent a total of 6,850 text messages in response to home measurement requests, of which 6,512 (95.1 percent) were identified as correctly-formatted blood pressures, blood sugars, and step counts, and automatically transferred to the medical record and point of care.
description: Text message response by patients of blood sugars, blood pressures, and step counts.
description: Datasets: 
DS1: Text Message Outreach for Complex Patients with Diabetes in Denver, CO, 2011-2012
description: Denver Health and Hospital Authority patients with diabetes.