Nundy S, Dick J, Goddu AP, Hogan P, Lu E, Solomon MC, Bussie A, Chin MH, Peek ME. Developing an Integrated Text Messaging Care Management Program for Diabetes. Poster presentation at the Midwest Regional Meeting of the Society for General Internal Medicine. September 14-15, 2012. Chicago, IL. Winner, Best Research Abstract – Poster Presentation.

1. Developing an Integrated Text Message-Based Care Management Program for Diabetes
Shantanu Nundy MD1, Jonathan J. Dick MD2, Anna P. Goddu MSc1, Patrick Hogan BA1, Emily Lu BA3, Marla C. Solomon RD CDE4, Arnell Bussie RN MPH5, Marshall H. Chin MD MPH1, Monica E. Peek MD MPH1
1 Section of General Internal Medicine, Department of Medicine, University of Chicago. 2 College of Physicians and Surgeons, Columbia University. 3 Pritzker School of Medicine, University of Chicago. 4 Section of Pediatric Endocrinology, University of Illinois at Chicago. 5 University of Chicago Health Plan.
Background Methods Results
Mobile phones are increasingly recognized as a viable An iterative process of program design built upon a pilot Nurse-administrators at health plan use automated text
platform for improving chronic care delivery in low- study and engaged multiple institutional stakeholders. messaging to provide personalized self-management
resource settings. support for member-patients with diabetes and facilitate
Our pilot study demonstrated high patient engagement and care coordination with the primary care team.
• Improving care for vulnerable populations: satisfaction.
Address patient-level barriers to medical care within the • Providing self-management support:
• 30-day intervention (n=18): automated self-management
resource constraints of current health systems Automated messages personalized to patient diabetes
reminders and weekly phone calls from administrator
care plan, self-management behaviors, and preferences.
• Availability of mobile phones and text messaging:
• High engagement (80% response rate), high satisfaction,
High rates of mobile phone ownership and texting usage • Supporting care management:
improved confidence in self-management (p<0.002)
among racial and ethnic minorities Members connect directly to nurse-care managers.
• Regular interaction with the text administrator important to System facilitates exception-based care coordination.
How to integrate into real-world systems? patient engagement.
• Front line health plan staff are key enablers:
Three key challenges: Despite increased workload, frontline staff enthusiastic
We engaged institutional stakeholders to translate these
• Maintaining level of patient engagement about increased patient contact.
findings into a funded initiative.
• Integrating with team-based care
• Identifying sustainable funding • Primary care physicians, endocrinologists, diabetes
educators, and administrators of University-affiliated
Purpose of the Study health plan, physician's group, and medical center
To develop a text message-based diabetes program for • Widely recognized need to integrate with primary care
University of Chicago Medicine (UCM) that could be both team, but concerns about demands on clinician time
sustainable and scalable. • Needed protocols for clinical oversight and patient privacy
Table 1. Sample text messages
Topic Message Type Example Text Message
Prompt Reminder: Time for your medicine!
Figure 1. Conceptual representation of the program
Medication Assessment In the last 7 days how many days did you take Discussion
all of your diabetes medications?
Education A good blood sugar within two hours after We have developed an innovative diabetes program that
eating is less than 180 mg/dl. A good fasting uses text messaging to provide self-management
(before breakfast) blood sugar is 80 to 125
mg/dl support and augmented care management services.
Glucose Encouragement Monitoring blood sugars is not just so your
Monitoring doctor knows how you are doing. Glucose • Care managers directly engage larger patient population
monitoring is a tool for YOU to know how you
are doing.
Automates time-consuming tasks, e.g. weekly outbound
Feedback 7 for 7, perfect job! calls or identifying members who require additional
support
Education Corn and potatoes may be vegetables, but
they are also starches that can increase your • Provides the critical 'human element‘
blood sugar. Stick to non-starchy vegetables
like spinach and carrots.
Facilitates sustained patient engagement, while
minimizing the impact on clinic workflows.
Tip If it's not in your kitchen, you probably won't
Nutrition eat it. Avoid temptation by not keeping
desserts or unhealthy snacks in the house.
Encouragement Developing a tasty but healthy food plan with
diabetes can be hard. Diabetes educators can
help. Do you want to meet with one? (yes/no)
Acknowledgments: Dr. Nundy is supported by the Agency for Healthcare Research and Quality Health Services Research Training Program (T32 HS00084). Dr Peek was supported by the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development program and the Mentored Patient-Oriented Career Development
Award of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (K23 DK075006). Dr. Chin is supported by a Midcareer Investigator Award in Patient-Oriented Research from the NIDDK (K24 DK071933). This research was also supported by the NIDDK Diabetes Research and Training Center (P60 DK20595) and the
Chicago Center for Diabetes Translation Research (P30 DK092949). Primary Care Group