Browsing by Author "Shardell, Michelle D"
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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