Browsing by Author "Gruber-Baldini, Ann L"
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- ItemCluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control.(2011-08-26) Quinn, Charlene C; Shardell, Michelle D; Terrin, Michael L; Barr, Erik A; Ballew, Shoshana H; Gruber-Baldini, Ann LOBJECTIVE To test whether adding mobile application coaching and patient provider web portals to community primary care compared with standard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes RESEARCH DESIGN AND METHODS A cluster randomized clinical trial the Mobile Diabetes Intervention Study randomly assigned 26 primary care practices to one of three stepped treatment groups or a control group usual care A total of 163 patients were enrolled and included in analysis The primary outcome was change in glycated hemoglobin levels over a 1 year treatment period Secondary outcomes were changes in patient reported diabetes symptoms diabetes distress depression and other clinical blood pressure and laboratory lipid values Maximal treatment was a mobile and web based self management patient coaching system and provider decision support Patients received automated real time educational and behavioral messaging in response to individually analyzed blood glucose values diabetes medications and lifestyle behaviors communicated by mobile phone Providers received quarterly reports summarizing patient s glycemic control diabetes medication management lifestyle behaviors and evidence based treatment options RESULTS The mean declines in glycated hemoglobin were 1 9 in the maximal treatment group and 0 7 in the usual care group a difference of 1 2 P 0 001 corrected over 12 months Appreciable differences were not observed between groups for patient reported diabetes distress depression diabetes symptoms or blood pressure and lipid levels all P 0 05 CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data lifestyle behaviors and patient self management data individually analyzed and presented with evidence based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year
- ItemAn mHealth Diabetes Intervention for Glucose Control: Health Care Utilization Analysis.(0000-00-00) Quinn, Charlene C; Swasey, Krystal K; Torain, Jamila M; Shardell, Michelle D; Terrin, Michael L; Barr, Erik A; Gruber-Baldini, Ann LBACKGROUND Type 2 diabetes T2D is a major chronic condition requiring management through lifestyle changes and recommended health service visits Mobile health mHealth is a promising tool to encourage self management but few studies have investigated the impact of mHealth on health care utilization OBJECTIVE The objective of this analysis was to determine the change in 2 year health service utilization and whether utilization explained a 1 9 absolute decrease in glycated hemoglobin HbA1c over 1 year in the Mobile Diabetes Intervention Study MDIS METHODS We used commercial claims data from 2006 to 2010 linked to enrolled patients medical chart data in 26 primary care practices in Maryland USA Secondary claims data analyses were available for 56 92 163 of participants In the primary MDIS study physician practices were recruited and randomized to usual care and 1 of 3 increasingly complex interventions Patients followed physician randomization assignment The main variables in the analysis included health service utilization by type of service and change in HbA1c The claims data was aggregated into 12 categories of utilization to assess change in 2 year health service usage comparing rates of usage pre and posttrial We also examined whether utilization explained the 1 9 decrease in HbA1c over 1 year in the MDIS cluster randomized clinical trial RESULTS A significant group by time effect was observed in physician office visits general practitioner visits other outpatient services prescription medications and podiatrist visits Physician office visits P 01 and general practitioner visits P 02 both decreased for all intervention groups during the study period whereas prescription claims PUnder 001 increased The frequency of other outpatient services P 001 and podiatrist visits P 04 decreased for the control group and least complex intervention group but increased for the 2 most complex intervention groups No significant effects of utilization were observed to explain the clinically significant change in HbA1c CONCLUSIONS Claims data analyses identified patterns of utilization relevant to mHealth interventions Findings may encourage patients and health providers to discuss the utilization of treatment recommended services lab tests and prescribed medications TRIAL REGISTRATION ClinicalTrials gov NCT01107015 https clinicaltrials gov ct2 show NCT01107015 Archived by Webcite at http www webcitation org 72XgTaxIj
- ItemMobile Diabetes Intervention for Glycemic Control in 45- to 64-Year-Old Persons With Type 2 Diabetes.(2016-01-05) Quinn, Charlene C; Shardell, Michelle D; Terrin, Michael L; Barr, Erik A; Park, DoHwan; Shaikh, Faraz; Guralnik, Jack M; Gruber-Baldini, Ann LThe purpose of this study was to assess effects of a mobile coaching system on glycated hemoglobin HbA1c levels in younger versus older patients over 1 year Participants n 118 included adult patients with Type 2 diabetes cared for by community physicians Intervention patients received mobile phone coaching and individualized web portal Control patients received usual care Patients were stratified into two age groups younger Under55 years and older 55 years The intervention resulted in greater 12 month declines in HbA1c compared with usual care for patients in both age groups p Under 0001 Among older patients HbA1c changed by 1 8 95 confidence interval CI 2 4 1 1 in the intervention group and 0 3 95 CI 0 9 0 3 in the control group Among younger patients HbA1c changed by 2 0 95 CI 2 5 1 5 in the intervention group and 1 0 95 CI 1 6 0 4 in the control group The mobile health intervention was as effective at managing Type 2 diabetes in older adults as younger persons
- ItemMobile Diabetes Intervention for Glycemic Control: Impact on Physician Prescribing.(2014-05-30) Quinn, Charlene C; Sareh, Patricia L; Shardell, Michelle L; Terrin, Michael L; Barr, Erik A; Gruber-Baldini, Ann LOf adults with type 2 diabetes 84 take antihyperglycemic medication Successful treatment requires active monitoring and medication dose adjustment by health providers The objective of this study was to determine how a mobile phone based coaching system for diabetes management influences physician prescribing behavior This secondary data analysis is based on a cluster randomized clinical trial that reported patients provided with mobile self management had reduction in glycated hemoglobin HbA1c of 1 9 over 1 year compared to 0 7 in control patients P Under 001 Participants were primary care patients with type 2 diabetes randomized at physician practice level into a control group n 55 and intervention group n 62 Main study measures were patients medication records medication dose frequency start and end date abstracted at baseline and study end Antihyperglycemic medications including sulfonylureas or thiazolidinediones and antihypertensive and antilipemic medications were analyzed A higher percentage of patients in the intervention group had modification and intensification of incretin mimetics during the 1 year study period 9 7 vs 0 0 and 8 1 vs 0 0 both P 008 A higher percentage of patients in the intervention group had modification and intensification of metformin 24 2 vs 7 3 P 033 The overall difference in physician prescribing of oral antihyperglycemic medications was not statistically significant Our results suggest mobile diabetes interventions can encourage physicians to modify and intensify antihyperglycemic medications in patients with type 2 diabetes Differences in physician prescribing behavior were modest and do not appear to be large enough to explain a 1 2 decrease in HbA1c
- ItemMobile diabetes intervention study: testing a personalized treatment/behavioral communication intervention for blood glucose control.(2009-05-18) Quinn, Charlene C; Gruber-Baldini, Ann L; Shardell, Michelle; Weed, Kelly; Clough, Suzanne S; Peeples, Malinda; Terrin, Michael; Bronich-Hall, Lauren; Barr, Erik; Lender, DanBACKGROUND National data find glycemic control is within target A1cUnder7 0 for 37 of patients with diabetes and only 7 meet recommended glycemic lipid and blood pressure goals OBJECTIVES To compare active interventions and usual care for glucose control in a randomized clinical trial RCT among persons with diabetes cared for by primary care physicians PCPs over the course of 1 year METHODS Physician practices n 36 in 4 geographic areas are randomly assigned to 1 of 4 study groups The intervention is a diabetes communication system using mobile phones and patient physician portals to allow patient specific treatment and communication All physicians receive American Diabetes Association ADA Guidelines for diabetes care Patients with poor diabetes control A1c or 7 5 at baseline n 260 are enrolled in study groups based on PCP randomization All study patients receive blood glucose BG meters and a year s supply of testing materials Patients in three treatment groups select one of two mobile phone models receive one year unlimited mobile phone data and service plan register on the web based individual patient portal and receive study treatment phone software based on study assignment Control group patients receive usual care from their PCP The primary outcome is mean change in A1c over a 12 month intervention period CONCLUSION Traditional methods of disease management have not achieved adequate control for BG and other conditions important to persons with diabetes Tools to improve communication between patients and PCPs may improve patient outcomes and be satisfactory to patients and physicians This RCT is ongoing