Managing Diabetes to Gain Opportunities for a More Active Life
Study Details
Study Description
Brief Summary
The purpose of this novel patient-facing disease management intervention is to develop and test a system embedded within the electronic medical record to engage patients in personalized goal setting and chronic disease management.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
The purpose of this novel patient-facing disease management intervention, My Diabetes GOAL, is to develop and test a system embedded within the electronic medical record to engage patients in personalized goal setting and chronic disease management by: 1) establishing personalized goals of care based on comorbidities and preferences, 2) tracking diabetes measures against personalized goals, and 3) selecting the route and intensity of care management to help patients achieve their goals (e.g., telephonic care management, in-person care management, and self-care resources). This application can be used to individualize care, increase engagement with patient portals, and improve patient self-efficacy, as they take a more active role in their care.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Intervention Patients that are enrolled in the intervention arm will receive an email message via MyChart (University of Chicago patient portal) to complete an initial questionnaire. Completion of the questionnaire will be required prior to initiating risk factor tracking and opening the portal to requests for care management support. A study team member (diabetes nurse educator) will contact the patient, if requested via the survey, to initiate telephonic care management or links to additional support services. Upon completion the study, all patients will receive a post-survey via MyChart. |
Behavioral: My Diabetes Goal Survey and Optional Care Management
The intervention is already described in the intervention arm description.
|
| Active Comparator: Delayed Intervention/Control Patients enrolled in the delayed intervention arm will receive usual care for the first 6 months, and then will receive the survey and intervention as stated above. |
Behavioral: My Diabetes Goal Survey and Optional Care Management
The intervention is already described in the intervention arm description.
|
Outcome Measures
Primary Outcome Measures
- Documentation of Diabetes Goal [1 year]
Documentation of a personalized goal for diabetes care (e.g., A1C target) of diabetes care (yes or no).
Secondary Outcome Measures
- Patient selection of personalized goals [1 year]
Patients will receive a pre-and post-survey in which they will be asked if they have diabetes care goals. We will measure these goals over time.
- Patient ability to reach personalized goals [1year]
Using EHR data, we will measure whether or not patients are reaching the goals they have documented in the survey.
Other Outcome Measures
- Health care utilization [1 year]
We will utilize the EHR to determine the frequency of referrals to telephone care management, the source of referrals (population management, physician), the patient predictors of referrals, and to characterize frequency and content of telephonic management.
Eligibility Criteria
Criteria
Inclusion Criteria:
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65 years and older
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Diagnosis of Type 2 Diabetes
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Enrolled in MyChart (University of Chicago Patient Portal)
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Outpatient clinic visit in the prior year
Exclusion Criteria:
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Under 64 years of age
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No type 2 diabetes
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Not enrolled in MyChart
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No outpatient clinic visit in the prior year
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Chicago | Chicago | Illinois | United States | 60637 |
Sponsors and Collaborators
- University of Chicago
Investigators
- Principal Investigator: Elbert S Huang, MD, University of Chicago
Study Documents (Full-Text)
More Information
Publications
None provided.- IRB18-0425