Enhancing diabetes care through care coordination, telemedicine, and education: Evaluation of a rural pilot program

Abstract

OBJECTIVE: To provide a comprehensive evaluation of a grant-funded pilot diabetes care program. Rural adult patients living with poorly controlled diabetes were targeted for care. DESIGN AND SAMPLE: Retrospective study using a purposive sample of patients at select primary care sites with a glycated hemoglobin (A1C) greater than 8%. Interventions included nurse care management, telemedicine endocrinology consults, as well as diabetes self-management education (DSME), to enhance disease management and prevention of complications. MEASURES: Pre/post labs, DSME test scores, hospital claims data, satisfaction surveys, and a focus group were evaluated. RESULTS: Fifty-nine adults, 21-76 years of age, participated. Interventions demonstrated statistically significant reduction in A1C (10.10 vs. 9.27; p value = 0.002); DSME test score improvement (76.23 vs. 96.04; p < 0.05) and reduced hospital utilization (Emergency Department use 0.86 vs. 0.40; p value = 0.04; inpatient admissions 0.09 vs. 0.02; p value = 0.02). Patients and providers indicated strong satisfaction with the program components. Less hospital utilization reduced emergency department costs by 51.4% and inpatient costs by 96%. A rural community advisory network indicated satisfaction in delivery of program activities and outcome measures. CONCLUSIONS: This rural model shows potential for improving diabetes control, access to specialty care through telemedicine, and reduction of health care utilization costs.