Chronic Care Management/Patient Relationship Management Proof of Concept

Study Overview
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Brief Summary
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This proof of concept study proposes to evaluate the feasibility of a communications-technology-based chronic care and patient relationship management program to improve diabetes self management among adult diabetic patients in an urban safety net population by providing between-visit reminders and chronic disease support through cell phone text messaging. The investigators hypothesize that diabetic patients enrolled in the program will be less likely to miss scheduled appointments and will have greater perceived self-efficacy and improved patient satisfaction concerning chronic disease management. No-show rates among patients enrolled in the program are expected to be lower than among patients receiving standard care.

Official Title
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Chronic Care Management/Patient Relationship Management Proof of Concept

Conditions
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Diabetes Mellitus

Intervention / Treatment
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* Behavioral: Patient Relationship Management (PRM) Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients with diabetes receive care at a primary care clinic in the DH system between 18 and 76 years of age primary language of English or Spanish ownership of a qualifying cell phone (SMS text capable) ownership of a glucometer. Exclusion Criteria: life expectancy less than six months, do not have or cannot use a phone or glucometer do not want to participate

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 76 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Behavioral: Patient Relationship Management (PRM) Program|Patients will be contacted through SMS text messaging under the following circumstances: 7 days, 2 days, and 1 day before scheduled appointments. Messages will contain the date, time, and location where the appointment is scheduled. Patients will be prompted to respond with 'YES' if they are able to keep their appointment, and 'NO' if they need to reschedule. An acknowledgement of receipt will be sent in response to all patient-initiated messages. 3 days per week to request that patients respond with fasting blood sugar measurements. An acknowledgement of receipt will be sent in response to all patient-initiated messages.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Engagement | Patient engagement was assessed by patient text message response rates and average response times. Response rates were calculated as a percentage from the number of patient-initiated text messages sent in response to a system-generated request for information (the numerator) divided by the total number of system-generated requests for information (the denominator). Average response times were calculated from system-recorded time stamps for outbound requests sent and inbound patient-initiated responses received. | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Appointment Attendance | As measured by no-show rates for appointments at all clinics during the study period, compared between intervention and control groups | 3 months | 
| Perceived Self-efficacy | As measured by comparison of patient responses to validated assessment instrument administered at baseline and post-intervention | 3 months | 
| Glycemic Control | Measured by patients' self-reported fasting blood glucose levels during the intervention period and compared to previous laboratory data in the medical record. | 3 months |