Researchers Study Impact of Diabetes Telemonitoring in Patient-Centered Medical Homes

New AHRQ-funded research uncovered important implementation considerations for telemonitoring of blood glucose and blood pressure in diabetes patients receiving care in patient-centered medical homes. The article and abstract, “Implementing Home Blood-Glucose and Blood-Pressure Telemonitoring in Primary Care Practices for Patients With Diabetes: Lessons Learned,” appeared online December 18 inTelemedicine and E-Health. Researchers gathered perspectives from stakeholders, including patients, nurse care coordinators, and physicians, to understand the impact of using information technology to monitor diabetes patients from a distance. Stakeholders emphasized the need to involve and prepare physicians and patients about how to effectively use telemonitoring. They also stressed the importance of considering workflows, flow of information, and human factors to optimize use of the technology.

2013 Dec 18. [Epub ahead of print]

Implementing Home Blood Glucose and Blood Pressure Telemonitoring in Primary Care Practices for Patients with Diabetes: Lessons Learned.

Koopman RJ, Wakefield BJ, Johanning JL, Keplinger LE, Kruse RL, Bomar M, Bernt B, Wakefield DS, Mehr DR.

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Abstract

Abstract Background: Prior telemonitoring trials of blood pressure and blood glucose have shown improvements in blood pressure and glycemic targets. However, implementation of telemonitoring in primary care practices may not yield the same results as research trials with extra resources and rigid protocols. In this study we examined the process of implementing home telemonitoring of blood glucose and blood pressure for patients with diabetes in six primary care practices. Materials and Methods: Grounded theory qualitative analysis was conducted in parallel with a randomized controlled effectiveness trial of home telemonitoring. Data included semistructured interviews with 6 nurse care coordinators and 12 physicians in six participating practices and field notes from exit interviews with 93 of 108 randomized patients. Results: The three stakeholder groups (patients, nurse care coordinators, and physicians) exhibited some shared themes and some unique to the particular stakeholder group. Major themes were that practices should (1) understand the capabilities and limitations of the technology and the willingness of patient and physician stakeholders to use it, (2) understand the workflow, flow of information, and human factors needed to optimize use of the technology, (3) engage and prepare the physicians, and (4) involve the patient in the process. Although there was enthusiasm for a patient-centered medical home model that included between-visit telemonitoring, there was concern about the support and resources needed to provide this service to patients. Conclusions: As with many technology interventions, careful consideration of workflow and information flow will help enable effective implementations.