A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study
Steven Shea, Ruth S Weinstock, Jeanne A Teresi, Walter Palmas, Justin Starren, James J Cimino, Albert M Lai, Lesley Field, Philip C Morin, Robin Goland, Roberto E Izquierdo, Susana Ebner, Stephanie Silver, Eva Petkova, Jian Kong, Joseph P Eimicke, IDEATel Consortium, Steven Shea, Justin Starren, Walter Palmas, Lesley Field, Robin Goland, Catherine Tuck, James Cimino, Albert Lai, Susana Ebner, Rafael Lantigua, David Kaufman, Charlyn Hilliman, David Liss, Sean Mota, Soumitra Sengupta, Vimla Patel, Mohammed Ashraf, Patricia Kringas, Jessica Rivera, Rene Bachmann, Vilma Moreno, Christine McGuinness, Iris Fernandez, David Baorto, Dimitri Borovtsov, Yao Huang, Rajhunathan Kamasmudram, Khalid Qureshi, Yuri Vayman, Linnea Capps, Alejandro Prigollini, Jeanne A Teresi, Douglas Holmes, Stephanie Silver, Jian Kong, Eva Petkova, Joseph P Eimicke, Onie Manzano, Mildred Ramirez, Ruth S Weinstock, Philip C Morin, Roberto Izquierdo, Thomas Wolff, Suzanne Meyer, Suzan M Carusone, Paul E Knudson, Fraser G Tudiver, Teresa J Wagner, Carina Lagua, Susan Fox, Susan West, Laura Ferri, JoAnn Shupe, Donald R Roller, Joseph Ziemba, David P Thomson, Kelly Duncan, Sarah Doolittle, Joanne Kearns, Deborah Bowerman, Pamela Suddaby, Kristine M Brindak, Paula Trief, Julia Morina, A L Lee, Shirley Seabury, John F Carroll, Frederic P Skinner, Terri L Ennis, Kathleen Sellers, Barbara Leo, Elsie Haus, Megan Wood, Barbara Gibbons, Catherine Cooney, Michael J Freeman, Susan Ulrich, Brian D Cassetta, Paul Bachman, Patricia Auer, Emily Hammond, Cairenn L Young, Mary M Beadnell, Timothy C Howland, Robert Catalano, Galvin Anderson, Terri N Kolasinski, Anil Shah, Kate R Fraczek, Terry Flynt, Julie Stone, John Taylor, Lurene R Tumiel, Marc Shilling, Chester Fox, David Kwiatkowski, Randall S Moore, C R Abbruscato, Karen Boril, Steven Shea, Ruth S Weinstock, Jeanne A Teresi, Walter Palmas, Justin Starren, James J Cimino, Albert M Lai, Lesley Field, Philip C Morin, Robin Goland, Roberto E Izquierdo, Susana Ebner, Stephanie Silver, Eva Petkova, Jian Kong, Joseph P Eimicke, IDEATel Consortium, Steven Shea, Justin Starren, Walter Palmas, Lesley Field, Robin Goland, Catherine Tuck, James Cimino, Albert Lai, Susana Ebner, Rafael Lantigua, David Kaufman, Charlyn Hilliman, David Liss, Sean Mota, Soumitra Sengupta, Vimla Patel, Mohammed Ashraf, Patricia Kringas, Jessica Rivera, Rene Bachmann, Vilma Moreno, Christine McGuinness, Iris Fernandez, David Baorto, Dimitri Borovtsov, Yao Huang, Rajhunathan Kamasmudram, Khalid Qureshi, Yuri Vayman, Linnea Capps, Alejandro Prigollini, Jeanne A Teresi, Douglas Holmes, Stephanie Silver, Jian Kong, Eva Petkova, Joseph P Eimicke, Onie Manzano, Mildred Ramirez, Ruth S Weinstock, Philip C Morin, Roberto Izquierdo, Thomas Wolff, Suzanne Meyer, Suzan M Carusone, Paul E Knudson, Fraser G Tudiver, Teresa J Wagner, Carina Lagua, Susan Fox, Susan West, Laura Ferri, JoAnn Shupe, Donald R Roller, Joseph Ziemba, David P Thomson, Kelly Duncan, Sarah Doolittle, Joanne Kearns, Deborah Bowerman, Pamela Suddaby, Kristine M Brindak, Paula Trief, Julia Morina, A L Lee, Shirley Seabury, John F Carroll, Frederic P Skinner, Terri L Ennis, Kathleen Sellers, Barbara Leo, Elsie Haus, Megan Wood, Barbara Gibbons, Catherine Cooney, Michael J Freeman, Susan Ulrich, Brian D Cassetta, Paul Bachman, Patricia Auer, Emily Hammond, Cairenn L Young, Mary M Beadnell, Timothy C Howland, Robert Catalano, Galvin Anderson, Terri N Kolasinski, Anil Shah, Kate R Fraczek, Terry Flynt, Julie Stone, John Taylor, Lurene R Tumiel, Marc Shilling, Chester Fox, David Kwiatkowski, Randall S Moore, C R Abbruscato, Karen Boril
Abstract
CONTEXT Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions and lower access to care. OBJECTIVES To examine the effectiveness of a telemedicine intervention to achieve clinical management goals in older, ethnically diverse, medically underserved patients with diabetes. DESIGN, Setting, and Patients A randomized controlled trial was conducted, comparing telemedicine case management to usual care, with blinded outcome evaluation, in 1,665 Medicare recipients with diabetes, aged >/= 55 years, residing in federally designated medically underserved areas of New York State. Interventions Home telemedicine unit with nurse case management versus usual care. Main Outcome Measures The primary endpoints assessed over 5 years of follow-up were hemoglobin A1c (HgbA1c), low density lipoprotein (LDL) cholesterol, and blood pressure levels. RESULTS Intention-to-treat mixed models showed that telemedicine achieved net overall reductions over five years of follow-up in the primary endpoints (HgbA1c, p = 0.001; LDL, p < 0.001; systolic and diastolic blood pressure, p = 0.024; p < 0.001). Estimated differences (95% CI) in year 5 were 0.29 (0.12, 0.46)% for HgbA1c, 3.84 (-0.08, 7.77) mg/dL for LDL cholesterol, and 4.32 (1.93, 6.72) mm Hg for systolic and 2.64 (1.53, 3.74) mm Hg for diastolic blood pressure. There were 176 deaths in the intervention group and 169 in the usual care group (hazard ratio 1.01 [0.82, 1.24]). CONCLUSIONS Telemedicine case management resulted in net improvements in HgbA1c, LDL-cholesterol and blood pressure levels over 5 years in medically underserved Medicare beneficiaries. Mortality was not different between the groups, although power was limited. Trial Registration https://ichgcp.net/clinical-trials-registry/NCT00271739" title="See in ClinicalTrials.gov">NCT00271739.
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Source: PubMed