Browsing by Author "Quinn, Charlene C"
Now showing 1 - 10 of 10
Results Per Page
Sort Options
- 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
- ItemEffect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy.(0000-00-00) Bilgrami, Zaid; Abutaleb, Ameer; Chudy-Onwugaje, Kenechukwu; Langenberg, Patricia; Regueiro, Miguel; Schwartz, David A; Tracy, J Kathleen; Ghazi, Leyla; Patil, Seema A; Quezada, Sandra M; Russman, Katharine M; Quinn, Charlene C; Jambaulikar, Guruprasad; Beaulieu, Dawn B; Horst, Sara; Cross, Raymond KINTRODUCTION Limitations in inflammatory bowel disease IBD care necessitate greater patient activation and self efficacy measures associated with positive health outcomes METHODS We assessed change in patient activation and general self efficacy from baseline to 12 months through our TELEmedicine for IBD trial a multicenter randomized controlled trial consisting of a web based monitoring system that interacts with participants via text messaging A total of 222 adults with IBD who had experienced an IBD flare within 2 years prior to the trial were randomized into either a control arm that received standard care SC or an intervention arm that completed self testing through the TELE IBD system every other week EOW or weekly W RESULTS Changes in self efficacy scores were not significantly different between control and experimental groups Patient activation scores were significantly different between standard care and the TELE IBD EOW group only p 0 03 CONCLUSIONS Use of remote monitoring did not improve self efficacy or patient activation compared to routine care
- ItemInflammatory Bowel Disease Telemedicine Clinical Trial: Impact of Educational Text Messages on Disease-Specific Knowledge Over 1 Year.(0000-00-00) Abutaleb, Ameer; Buchwald, Andrea; Chudy-Onwugaje, Kenechukwu; Langenberg, Patricia; Regueiro, Miguel; Schwartz, David A; Tracy, J Kathleen; Ghazi, Leyla; Patil, Seema A; Quezada, Sandra M; Russman, Katharine M; Quinn, Charlene C; Jambaulikar, Guruprasad; Beaulieu, Dawn B; Horst, Sara; Cross, Raymond KBackground Effective treatments are available for patients with inflammatory bowel disease IBD however suboptimal outcomes occur and are often linked to patients limited disease knowledge The aim of this analysis was to determine if delivery of educational messages through a telemedicine system improves IBD knowledge Methods TELEmedicine for Patients with IBD TELE IBD was a randomized controlled trial with visits at baseline 6 months and 12 months patient knowledge was a secondary aim of the study Patients were randomized to receive TELE IBD every other week EOW weekly TELE IBD W or standard of care Knowledge was assessed at each visit with the Crohn s and Colitis Knowledge CCKNOW survey The primary outcome was change in CCKNOW score over 1 year compared between the TELE IBD and control groups Results This analysis included 219 participants Participants in the TELE IBD arms had a greater improvement in CCKNOW score compared with standard care TELE IBD EOW 2 4 vs standard care 1 8 P 0 03 TELE IBD W 2 0 vs standard care 1 8 P 0 35 Participants with lower baseline CCKNOW scores had a greater change in their score over time P Under 0 01 However after adjusting for race site and baseline knowledge there was no difference in CCKNOW score change between the control and telemedicine arms Conclusions Telemedicine improves IBD specific knowledge through text messaging although the improvement is not additive with greater frequency of text messages However after adjustment for confounding variables telemedicine is not superior to education given through standard visits at referral centers Further research is needed to determine if revised systems with different modes of delivery and or frequency of messages improve disease knowledge
- 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
- ItemA Randomized Controlled Trial of TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD).(0000-00-00) Cross, Raymond K; Langenberg, Patricia; Regueiro, Miguel; Schwartz, David A; Tracy, J Kathleen; Collins, Joseph F; Katz, Jonathan; Ghazi, Leyla; Patil, Seema A; Quezada, Sandra M; Beaulieu, Dawn; Horst, Sara N; Russman, Katharine; Riaz, Mahrukh; Jambaulikar, Guruprasad; Sivasailam, Barathi; Quinn, Charlene CINTRODUCTION Telemedicine has shown promise in inflammatory bowel disease IBD The objective of this study was to compare disease activity and quality of life QoL in a 1 year randomized trial of IBD patients receiving telemedicine versus standard care METHODS Patients with worsening symptoms in the prior 2 years were eligible for randomization to telemedicine monitoring via texts EOW or weekly or standard care The primary outcomes were the differences in change in disease activity and QoL between the groups change in health care utilization among groups was a secondary aim RESULTS 348 participants were enrolled 117 control group 115 TELE IBD EOW and 116 TELE IBD weekly 259 74 4 completed the study Age was 38 9 12 3 years 56 6 were women 91 9 were Caucasian 67 9 had Crohn s disease CD and 42 5 had active disease at baseline In CD all groups experienced a decrease in disease activity control 5 2 5 0 to 3 7 3 6 TELE IBD EOW 4 7 4 1 to 4 2 3 9 and TELE IBD weekly 4 2 4 2 to 3 2 3 4 p Under 0 0001 for each of the groups In UC only controls had a significant decrease in disease activity control 2 9 3 1 to 1 4 1 4 p 0 01 TELE IBD EOW 2 7 3 1 to 1 7 1 9 p 0 35 and TELE IBD Weekly 2 5 2 5 to 2 0 1 8 p 0 31 QoL increased in all groups the increase was significant only in TELE IBD EOW control 168 1 34 0 to 179 3 28 2 p 0 06 TELE IBD EOW 172 3 33 1 to 181 5 28 2 p 0 03 and TELE IBD Weekly 172 3 34 5 to 179 2 32 8 p 0 10 Unadjusted and adjusted changes in disease activity and QoL were not significantly different among groups Health care utilization increased in all groups TELE IBD weekly were less likely to have IBD related hospitalizations and more likely to have non invasive diagnostic tests and electronic encounters compared to controls both TELE IBD groups had decreased non IBD related hospitalizations and increased telephone calls compared to controls DISCUSSION Disease activity and QoL although improved in all participants were not improved further through use of the TELE IBD system TELE IBD participants experienced a decrease in hospitalizations with an associated increase in non invasive diagnostic tests telephone calls and electronic encounters Research is needed to determine if TELE IBD can be improved through patient engagement and whether it can decrease healthcare utilization by replacing standard care
- ItemTelehealth Remote Monitoring Systematic Review: Structured Self-monitoring of Blood Glucose and Impact on A1C.(2014-05-30) Greenwood, Deborah A; Young, Heather M; Quinn, Charlene CThe aim was to summarize research on telehealth remote patient monitoring interventions that incorporate key elements of structured self monitoring of blood glucose SMBG identified as essential for improving A1C A systematic review was conducted using the Medline Cumulative Index to Nursing and Allied Health Literature EMBASE and OVID Medline databases with search terms Telemedicine AND Monitoring Physiologic AND Diabetes Mellitus Type 2 Study selection criteria included original randomized clinical trials evaluating the impact of telehealth remote patient monitoring on A1C among adults with type 2 diabetes and incorporated 1 or more essential elements of SMBG identified by the International Diabetes Federation patient education provider education structured SMBG profile SMBG goals feedback data used to modify treatment interactive communication or shared decision making Fifteen studies were included with interventions ranging from 3 to 12 months mean 8 months with sample sizes from 30 to 1665 Key SMBG elements were grouped into 3 categories education SMBG protocols and feedback Research incorporating 5 of the 7 elements consistently achieved significant A1C improvements between study groups Interventions using more SMBG elements are associated with an improvement in A1C Studies with the largest A1C decrease incorporated 6 of the 7 elements and computer decision support Two studies with 5 of the 7 elements and active medication management achieved significant A1C decreases Telehealth remote patient monitoring interventions in type 2 diabetes have not included all structured monitoring elements recommended by the IDF Incorporating more elements of structured SMBG is associated with improved A1C
- ItemWellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction.(2008-05-13) Quinn, Charlene C; Clough, Suzanne Sysko; Minor, James M; Lender, Dan; Okafor, Maria C; Gruber-Baldini, AnnBACKGROUND Less than 63 of individuals with diabetes meet professional guidelines target of hemoglobin A1c Under7 0 and only 7 meet combined glycemic lipid and blood pressure goals The primary study aim was to assess the impact on A1c of a cell phone based diabetes management software system used with web based data analytics and therapy optimization tools Secondary aims examined health care provider HCP adherence to prescribing guidelines and assessed HCPs adoption of the technology METHODS Thirty patients with type 2 diabetes were recruited from three community physician practices for a 3 month study and evenly randomized The intervention group received cell phone based software designed by endocrinologists and CDEs WellDoc Communications Inc Baltimore MD The software provided real time feedback on patients blood glucose levels displayed patients medication regimens incorporated hypo and hyperglycemia treatment algorithms and requested additional data needed to evaluate diabetes management Patient data captured and transferred to secure servers were analyzed by proprietary statistical algorithms The system sent computer generated logbooks with suggested treatment plans to intervention patients HCPs RESULTS The average decrease in A1c for intervention patients was 2 03 compared to 0 68 P Under 0 02 one tailed for control patients Of the intervention patients 84 had medications titrated or changed by their HCP compared to controls 23 P 0 002 Intervention patients HCPs reported the system facilitated treatment decisions provided organized data and reduced logbook review time CONCLUSIONS Adults with type 2 diabetes using WellDoc s software achieved statistically significant improvements in A1c HCP and patient satisfaction with the system was clinically and statistically significant