National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Blood Pressure (3)
- Care Management (1)
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- Comparative Effectiveness (1)
- COVID-19 (2)
- (-) Diabetes (20)
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- Health Information Technology (HIT) (17)
- Health Promotion (1)
- Kidney Disease and Health (1)
- Lifestyle Changes (2)
- Low-Income (3)
- Nursing (1)
- Outcomes (1)
- Patient-Centered Healthcare (3)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (3)
- Patient and Family Engagement (1)
- Patient Self-Management (12)
- Pregnancy (1)
- Prevention (2)
- Primary Care (4)
- Public Health (1)
- Racial and Ethnic Minorities (2)
- Risk (1)
- Rural Health (1)
- (-) Telehealth (20)
- Vulnerable Populations (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedAA Payán, DD Brown, TT
AHRQ Author: Tierney
Telehealth use, care continuity, and quality: diabetes and hypertension care in community health centers before and during the COVID-19 pandemic.
In a cohort study, researchers examined the association of care continuity with diabetes and hypertension care quality in community health centers (CHCs) before and during COVID-19, and the mediating effect of telehealth. Patients with diabetes and/or hypertension with at least 2 encounters per year during 2019 and 2020 were identified via electronic health record data from 166 CHCs; multivariable logistic regression models estimated the association of care continuity with telehealth use and care processes. The results showed that higher care continuity was associated with telehealth use and A1c testing, and lower A1c and blood pressure. The researchers concluded that care continuity might facilitate telehealth use and resilient performance on process measures.
AHRQ-funded; HS022241.
Citation: AA Payán, DD Brown, TT .
Telehealth use, care continuity, and quality: diabetes and hypertension care in community health centers before and during the COVID-19 pandemic.
Med Care 2023 Apr 1;61(Suppl 1):S62-s69. doi: 10.1097/mlr.0000000000001811.
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Diabetes, Blood Pressure, Community-Based Practice, Public Health
Fareed N, Swoboda C, Singh P
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
The objective of this study was to develop user specifications for a tailored and integrated technology, patient application (mHealth) and provider dashboard, that provides a complete view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy and to develop prototypes based on users’ needs. Participating patients and providers stated a core set of expectations for the mHealth and dashboard applications. Participants then provided feedback to improve these applications. The authors concluded that digital health tools could transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels. Refining the stated needs and preferences of patients and providers to develop applications holds potential for tackling complicated health care issues.
AHRQ-funded; HS028822.
Citation: Fareed N, Swoboda C, Singh P .
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
Digit Health 2023 Jan-Dec; 9:20552076221144181. doi: 10.1177/20552076221144181..
Keywords: Patient-Centered Healthcare, Telehealth, Diabetes, Pregnancy, Chronic Conditions, Women, Health Information Technology (HIT)
Rodriguez HP, Ciemins EL, Rubio K
Health systems and telemedicine adoption for diabetes and hypertension care.
This study examined differences in telemedicine use for adults with diabetes and/or hypertension across 10 health systems and analyzed practice and patient characteristics associated with greater use. Encounter-level data from the AMGA Optum Data Warehouse for March 13, 2020 to December 31, 2020 were analyzed. This included 3,016,761 clinical encounters from 764,521 adults with diabetes and/or hypertension attributed to 1 of 1207 practice sites with at least 50 system-attributed patients. Telemedicine use time was divided into adoption (weeks 0-4), de-adoption (weeks 5-12), and maintenance (weeks 13-42) periods. Telemedicine use peaked after 4 weeks at 11-42% of weekly encounters. Small practices had lower telemedicine use for adults with diabetes during the maintenance period compared with larger practices, with ownership showing no association with telemedicine use. Practices with higher proportions of Black patients continued their expansion of telemedicine use during the de-adoption and maintenance periods.
Citation: Rodriguez HP, Ciemins EL, Rubio K .
Health systems and telemedicine adoption for diabetes and hypertension care.
Am J Manag Care 2023 Jan; 29(1):42-49. doi: 10.37765/ajmc.2023.89302..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Blood Pressure, Chronic Conditions
Grauer A, Duran AT, Liyanage-Don NA
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
The purpose of this retrospective cohort study was to explore whether there is a relationship between telemedicine use in primary care and risk factor assessment and control for patients with diabetes mellitus. The study included patients with diabetes mellitus ages 18-75 with a telemedicine visit in a primary care network between February 2020 and December 2020. Researchers evaluated whether low-density lipoprotein cholesterol (LDL-C), blood pressure (BP), and hemoglobin A1c (HbA1c) and were assessed for each patient. The study identified 1,824 patients with diabetes during the study period and found that telemedicine use was associated with a lower proportion of patients with all three risk factors assessed. The researchers concluded that telemedicine use was related with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic.
AHRQ-funded; HS026121; HS024262.
Citation: Grauer A, Duran AT, Liyanage-Don NA .
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
J Endocrinol Invest 2022 Sep;45(9):1749-56. doi: 10.1007/s40618-022-01814-6..
Keywords: Diabetes, Chronic Conditions, Telehealth, Health Information Technology (HIT), Primary Care, Risk
Roddy MK, Mayberry LS, Nair D
Exploring mHealth potential to improve kidney function: secondary analysis of a randomized trial of diabetes self-care in diverse adults.
This study examined whether REACH, a text message-delivered self-management support intervention, which focuses on medication adherence, diet, and exercise can significantly improve glycemic control in 506 chronic kidney disease (CKD) patients with Type 2 Diabetes (T2D). The authors used data from the trial to explore the intervention’s effect on change in estimated glomerular filtration rate (eGR) at 12 months in a subsample of 271 patients. Patients with proteinuria at baseline who received REACH had less worsening of eGFR.
AHRQ-funded; HS026395.
Citation: Roddy MK, Mayberry LS, Nair D .
Exploring mHealth potential to improve kidney function: secondary analysis of a randomized trial of diabetes self-care in diverse adults.
BMC Nephrol 2022 Aug 10;23(1):280. doi: 10.1186/s12882-022-02885-6..
Keywords: Telehealth, Health Information Technology (HIT), Patient Self-Management, Diabetes, Chronic Conditions, Kidney Disease and Health, Patient Adherence/Compliance
Brown SD, Hedderson MM, Gordon N
Reach, acceptability, and perceived success of a telehealth diabetes prevention program among racially and ethnically diverse patients with gestational diabetes: the gem cluster-randomized trial.
The purpose of this study was to describe overall and race/ethnicity-specific reach, acceptability, and perceived success from an effective telehealth diabetes prevention lifestyle program for patients with gestational diabetes mellitus, implemented in the Gestational Diabetes Effects on Moms (GEM) cluster-randomized controlled trial. An intervention of 13 telephone sessions and behavior change techniques (BCTs) in a healthcare system were tested by GEM. Survey respondents largely rated BCTs as very helpful. Black and White respondents reported more limited success reaching a healthy weight than Asian/Pacific Islander, Hispanic, and multiracial/other women. The researchers concluded that a telehealth diabetes prevention lifestyle program showed both reach and acceptability across racial/ethnic groups, and that similar interventions could encourage preventive care access and help reduce disparities in the risk for diabetes.
AHRQ-funded; HS019367.
Citation: Brown SD, Hedderson MM, Gordon N .
Reach, acceptability, and perceived success of a telehealth diabetes prevention program among racially and ethnically diverse patients with gestational diabetes: the gem cluster-randomized trial.
Transl Behav Med 2022 Jul 18;12(7):793-99. doi: 10.1093/tbm/ibac019..
Keywords: Diabetes, Chronic Conditions, Telehealth, Health Information Technology (HIT), Prevention, Lifestyle Changes
Rodriguez DV, Lawrence K, Luu S
Development of a computer-aided text message platform for user engagement with a digital diabetes prevention program: a case study.
Investigators partnered with a Digital Diabetes Prevention Programs (dDPP) vendor to develop a personalized automatic message system (PAMS) to promote user engagement to the dDPP platform by sending messages on behalf of the user’s primary care provider. In this article, they discussed the design and development of their system, including key requirements and features, the technical architecture and build, and preliminary user testing.
AHRQ-funded; HS026120.
Citation: Rodriguez DV, Lawrence K, Luu S .
Development of a computer-aided text message platform for user engagement with a digital diabetes prevention program: a case study.
J Am Med Inform Assoc 2021 Dec 28;29(1):155-62. doi: 10.1093/jamia/ocab206..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Prevention
Misra-Hebert AD, Hu B, Pantalone KM
Primary care health care use for patients with type 2 diabetes during the COVID-19 pandemic.
This study sought to examine factors associated with total and virtual primary care use for patients with type 2 diabetes (T2D) during the COVID-19 pandemic. This study used electronic medical records in the Cleveland Clinic Health System comparing prepandemic use from August 2019 to March 2020 (baseline period 0) to two pandemic periods: March to June 2020 (period 1) when in-person visits were converted to virtual; and July to November 2020 when in-person visits resumed (period 2). Demographic characteristics were obtained including age, sex, race, insurance type, median income estimated by zip code and baseline HbA1C. The study included 76,015 patients with T2D who completed a primary care visit in baseline period 0. Cohort median age was 66.2 years, 50.7% women, 21.7% Black, 71.0% White and 7.4 Other. Insurance distribution was 43.2% private, 46.5% Medicare, and 9.5% Medicaid. Median income was estimated at $59,000 and baseline HbA1C was ≤ 7% for 59.6% of patients. There were higher odds of Black patients, those with uncontrolled T2D, and those with Medicare and Medicare using virtual visits during the 2 postpandemic periods suggesting that virtual visits may be a preference for those groups. Older and male patients had lower odds of visit completion.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Pantalone KM .
Primary care health care use for patients with type 2 diabetes during the COVID-19 pandemic.
Diabetes Care 2021 Sep;44(9):e173-e74. doi: 10.2337/dc21-0853..
Keywords: COVID-19, Diabetes, Primary Care, Telehealth, Health Information Technology (HIT), Healthcare Delivery, Access to Care, Chronic Conditions
Oikonomidi T, Ravaud P, James A
AHRQ Author: Montori V
An international, mixed-methods study of the perceived intrusiveness of remote digital diabetes monitoring.
This paper describes an international online vignette-based survey to assess the relationship between remote digital monitoring (RDM) modalities for diabetes and intrusiveness in patients’ lives. The survey was conducted from February-June 2019 in 30 countries with 1010 participants. A total of 2680 vignette-assessments were completed with 52% on type 1 diabetes. Increased intrusiveness was associated with food monitoring compared with glucose- and PA-monitoring alone and permanent monitoring with real-time physician-generated feedback compared with monitoring for a week with feedback. Public-sector data handling was associated with decreased intrusiveness as compared with the private sector.
AHRQ-authored.
Citation: Oikonomidi T, Ravaud P, James A .
An international, mixed-methods study of the perceived intrusiveness of remote digital diabetes monitoring.
Mayo Clin Proc 2021 May;96(5):1236-47. doi: 10.1016/j.mayocp.2020.07.040..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Lifestyle Changes, Patient Self-Management
Oikonomidi T, Ravaud P, Cosson E
AHRQ Author: Montori V
Evaluation of patient willingness to adopt remote digital monitoring for diabetes management.
Investigators sought to identify the minimum effectiveness patients report they require to adopt 36 different remote digital monitoring (RDM) scenarios. Adults with type 1 or type 2 diabetes living in 30 countries assessed three randomly selected scenarios from a total of 36 that described different combinations of digital monitoring tools. The investigators found that patients required greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. They recommended that patient monitoring devices be designed to be minimally intrusive.
AHRQ-authored.
Citation: Oikonomidi T, Ravaud P, Cosson E .
Evaluation of patient willingness to adopt remote digital monitoring for diabetes management.
JAMA Netw Open 2021 Jan;4(1):e2033115. doi: 10.1001/jamanetworkopen.2020.33115..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Care Management, Patient Self-Management, Patient Adherence/Compliance
Howland C, Despins L, Sindt J
Primary care clinic nurse activities with a telehealth monitoring system.
The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients using a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those assuming usual care. Significant differences were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up, providing evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.
AHRQ-funded; HS017035.
Citation: Howland C, Despins L, Sindt J .
Primary care clinic nurse activities with a telehealth monitoring system.
West J Nurs Res 2021 Jan;43(1):5-12. doi: 10.1177/0193945920923082..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Primary Care, Clinician-Patient Communication, Communication, Patient Self-Management, Nursing, Patient-Centered Healthcare, Diabetes
Presley C, Agne A, Shelton T
Mobile-enhanced peer support for African Americans with Type 2 diabetes: a randomized controlled trial.
This study compared the effectiveness of a community-based diabetes self-management education (DSME) plus mobile health (mHealth)-enhanced peer support intervention to community-based DSME alone for African American adults with poorly controlled type 2 diabetes. This randomized controlled trial took place in Jefferson County, Alabama within a safety-net healthcare system with a group diagnosed with type 2 diabetes and hemoglobin A1C ≥ 7.5%. The intervention group reviewed community-based DSME plus 6 months of mHealth-enhanced peer support, including 12 weekly phone calls, then 3 monthly calls from community health workers. The control group received community based DSME only. Primary outcomes were lower A1C and secondary outcomes were lower diabetes distress, depressive symptoms, self-efficacy or confidence in their ability to manage diabetes, and social support. Of 120 participants selected, 97 completed the study. Both groups experienced clinical meaning reduction in A1C. Participants in the intervention group experienced a significantly larger reduction in diabetes distress compared to the control group.
AHRQ-funded; HS019465.
Citation: Presley C, Agne A, Shelton T .
Mobile-enhanced peer support for African Americans with Type 2 diabetes: a randomized controlled trial.
J Gen Intern Med 2020 Oct;35(10):2889-96. doi: 10.1007/s11606-020-06011-w..
Keywords: Telehealth, Health Information Technology (HIT), Patient Self-Management, Diabetes, Chronic Conditions, Racial and Ethnic Minorities, Community-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Education: Patient and Caregiver
Aguilera A, Figueroa CA, Hernandez-Ramos R
mHealth app using machine learning to increase physical activity in diabetes and depression: clinical trial protocol for the DIAMANTE study.
In this randomized controlled trial, the researchers’ goal is to examine the effect of a text-messaging smartphone application to encourage physical activity in low-income ethnic minority patients with comorbid diabetes and depression. They will compare passively collected daily step counts, self-reported PHQ-8 and most recent hemoglobin A1c from medical records at baseline and at intervention completion at 6-month follow-up. They plan to submit manuscripts describing their user-designed methods and testing of the adaptive learning algorithm and will submit the results of the trial for publication in peer-reviewed journals and presentations at scientific meetings.
AHRQ-funded; HS025429.
Citation: Aguilera A, Figueroa CA, Hernandez-Ramos R .
mHealth app using machine learning to increase physical activity in diabetes and depression: clinical trial protocol for the DIAMANTE study.
BMJ Open 2020 Aug 20;10(8):e034723. doi: 10.1136/bmjopen-2019-034723..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Racial and Ethnic Minorities, Low-Income, Health Promotion
Mayberry LS, Lyles CR, Oldenburg B
mHealth interventions for disadvantaged and vulnerable people with type 2 diabetes.
The authors evaluate the impact of diabetes self-management interventions delivered via mobile device and/or Internet on glycemic control of disadvantaged/vulnerable adults with type 2 diabetes. They found evidence suggesting that digital interventions can improve diabetes control, healthcare utilization, and healthcare costs. More research to substantiate these early findings is recommended; the authors suggest that many issues remain in order to optimize the impact of digital interventions on the health outcomes of disadvantaged/vulnerable persons with diabetes.
AHRQ-funded; HS022408; HS025429.
Citation: Mayberry LS, Lyles CR, Oldenburg B .
mHealth interventions for disadvantaged and vulnerable people with type 2 diabetes.
Curr Diab Rep 2019 Nov 25;19(12):148. doi: 10.1007/s11892-019-1280-9.
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Keywords: Diabetes, Vulnerable Populations, Patient Self-Management, Telehealth, Health Information Technology (HIT), Patient-Centered Healthcare, Low-Income, Chronic Conditions
Mayberry LS, Berg CA, Harper KJ
The design, usability, and feasibility of a family-focused diabetes self-care support mHealth intervention for diverse, low-income adults with type 2 diabetes.
Through user-centered design and iterative usability/feasibility testing, the researchers developed a mobile Health intervention for disadvantaged adults with type 2 diabetes (T2D) called FAMS. FAMS delivers phone coaching to set self-care goals and improve patient participant's (PP) ability to identify and address family actions that support/impede self-care. PPs reported FAMS increased self-care and both PPs and support persons reported FAMS improved support for and communication about diabetes.
AHRQ-funded; HS022990.
Citation: Mayberry LS, Berg CA, Harper KJ .
The design, usability, and feasibility of a family-focused diabetes self-care support mHealth intervention for diverse, low-income adults with type 2 diabetes.
J Diabetes Res 2016;2016:7586385. doi: 10.1155/2016/7586385.
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Keywords: Diabetes, Low-Income, Patient and Family Engagement, Patient Self-Management, Telehealth
Cherrington AL, Agne AA, Lampkin Y
Diabetes Connect: developing a mobile health intervention to link diabetes community health workers with primary care.
The authors tested a model for the integration of a community health worker-delivered mobile health technology intervention to improve diabetes self-management. They found that the integration of mobile health technology into community health worker programs was successfully achieved and readily accepted.
AHRQ-funded; HS019465.
Citation: Cherrington AL, Agne AA, Lampkin Y .
Diabetes Connect: developing a mobile health intervention to link diabetes community health workers with primary care.
J Ambul Care Manage 2015 Oct-Dec;38(4):333-45. doi: 10.1097/jac.0000000000000110.
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Keywords: Education: Patient and Caregiver, Diabetes, Primary Care, Patient Self-Management, Telehealth
Lepard MG, Joseph AL, Agne AA
Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review.
The authors systematically reviewed the evidence for the impact of diabetes self-management education interventions designed for patients living in rural areas on glycemic control and other diabetes outcomes. They were able to identify examples of both telehealth interventions and face-to-face interventions that resulted in improved behavioral, biologic, and diabetes knowledge-related outcomes in adults with T2DM living in rural areas.
AHRQ-funded; HS019465.
Citation: Lepard MG, Joseph AL, Agne AA .
Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review.
Curr Diab Rep 2015 Jun;15(6):608. doi: 10.1007/s11892-015-0608-3..
Keywords: Diabetes, Patient Self-Management, Rural Health, Telehealth, Health Information Technology (HIT)
Fuji KT, Abbott AA, Galt KA
A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record.
The authors explored how patients with type 2 diabetes used a personal health record (PHR) to manage their diabetes-related health information for self-care. They found that, despite some potential positive benefits resulting from PHR use, several barriers inhibited sustained and effective use over time. They concluded that provider and patient education about the benefits of PHR use and about the potential for filling in information gaps in the provider-based record is key to engage patients and stimulate PHR adoption and use.
AHRQ-funded; HS018625.
Citation: Fuji KT, Abbott AA, Galt KA .
A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record.
Telemed J E Health 2015 Apr;21(4):296-300. doi: 10.1089/tmj.2014.0084.
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Keywords: Diabetes, Electronic Health Records (EHRs), Patient Self-Management, Telehealth
Nundy S, Mishra A, Hogan P
How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study.
The purpose of this study was to investigate the behavioral effects of a theory-driven, mobile phone–based intervention that combines automated text messaging and remote nursing, using an automated, interactive text messaging system. It found that the intervention was associated with improvements in 5 of 6 domains of self-care (medication taking, glucose monitoring, foot care, exercise, and healthy eating).
AHRQ-funded; HS015054.
Citation: Nundy S, Mishra A, Hogan P .
How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study.
Diabetes Educ 2014 Nov-Dec;40(6):806-19. doi: 10.1177/0145721714551992..
Keywords: Diabetes, Health Information Technology (HIT), Patient Self-Management, Telehealth
Nundy S, Dick JJ, Chou CH
Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants.
Mobile phones are a promising tool to use in engaging patients in behavior change and facilitating self-care between visits. The researchers examined the impact of a six-month mobile health (mHealth) demonstration project among adults with diabetes. In addition to pre-post improvements in glycemic control and patients’ satisfaction with overall care, they observed a net cost savings of 8.8 percent.
AHRQ-funded; HS000084.
Citation: Nundy S, Dick JJ, Chou CH .
Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants.
Health Aff 2014 Feb;33(2):265-72. doi: 10.1377/hlthaff.2013.0589..
Keywords: Diabetes, Health Information Technology (HIT), Patient Adherence/Compliance, Patient Self-Management, Telehealth