Automated SMS-Based Appointment Validation Tool

Study Overview
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Brief Summary
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Medic Mobile conceptualized and proposed the creation of an SMS-based appointment validation tool to automate appointment confirmation and rescheduling. Working in parallel with the San Mateo Medical Center (SMMC) electronic medical records (EMR) system, the software tool will automate reminders that request text responses from patients to either confirm or request to reschedule their upcoming appointments. While simple in concept, this tool aims to free up scarce clinical resources which are currently allocated to daily patient phone call reminders. With funding from a Bay Area foundation, the investigators will develop and pilot this open-source software tool in a 12-month randomized-controlled trial, slated to begin in October 2012. The endpoints of the study will aim to demonstrate improvements in both appointment adherence and glycemic control.

Official Title
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An Automated SMS-Based Reminder and Rescheduling Tool to Improve Appointment Adherence Rates and Glycemic Control Among Diabetes Patients in San Mateo County

Conditions
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Diabetes Mellitus Type 2, Adult-onset Diabetes

Intervention / Treatment
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* Other: SMS Reminder Software Tool


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Belong to Willow Clinic or Fair Oaks Clinic under the San Mateo Medical Center Have a diagnosis of type 2 diabetes as indicated by ICD-9 code of 249.xx or 250.xx Have a most recent hemoglobin A1c (HbA1c) level greater than 7% Are at least 18 years of age Have access to cell phone Are literate or live with a friend/family member who is literate and willing to handle associated text messages Exclusion Criteria: Have a terminal illness and prognosis of less than one year Are unable to demonstrate the ability to reply to an SMS and lack an appropriate proxy Are pregnant or expect to be pregnant in the next 6-9 months

Ages Eligible for Study
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Minimum Age: 18 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SMS Appointment Reminders<br>150 patients will be randomly assigned to the intervention arm of the study and receive text reminders about their upcoming appointments. | Other: SMS Reminder Software Tool<br>* The 150 patients in the intervention arm of the study will receive SMS reminders regarding their upcoming appointments. Working in parallel with the SMMC electronic medical records system, the software tool will automate reminders that request text responses from patients to either confirm or request to reschedule their upcoming appointments. This bidirectional text messaging system would not interfere with the clinics' existing reminder protocol.<br>|
| No Intervention: Existing Reminder Protocol<br>150 patients will be randomly assigned to the control arm of the study and will not receive SMS reminders about their upcoming appointments. They will, however, be subject to the clinics' existing reminder protocol (phone call reminders by either clinic personnel or computer machine). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Glycemic Control (hemoglobin A1c) | The hemoglobin A1c (HbA1c) levels of study participants will be measured at the time of enrollment and at the end of the 6-9 month follow-up period. | 6-9 months post-enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Appointment Adherence Rate | Appointments scheduled during the 6-9 month follow-up period will be systematically tracked and monitored. The proportion of fulfilled appointments will be compared between the intervention and control arms. | 6-9 month post-enrollment |