“Real World” Implementation of a Cell Phone-Based Diabetes Management Program in a Community-Based Clinic

Objective: The DC Chronic Care Initiative (DC-CCI) is supporting a cell phone (CP) -based diabetes intervention in a high-risk minority population. Primary objective is to reduce hospitalizations and emergency room visits.

Methods: The DC-CCI CP Intervention is recruiting patients from a Medicaid PPO. Patients connect with the WellDoc Diabetes Manager® system using their own CPs which must be web-enabled. This demonstration project will test the feasibility and cost effectiveness of a CP assisted disease management program in a low income population.

Results: “Real world” implementation of the program has presented challenges related to the population, primary healthcare providers, and technology required. We screened patient records to identify eligible participants. Despite low income, 80% of 79 patients who could be contacted had CPs. Of the potential participants 55% used prepaid phones and 45% had phone contracts across 4 different service carriers. Few patients had phone service with internet capability. To improve affordability we negotiated necessary upgrades of handsets and service contracts with wireless companies. The healthcare team –primary care providers, case managers and healthcare administrators must ‘buy-in’ to the system.  Through outreach and education their help has been invaluable in tailoring the components of the system to a simple patient-friendly version that integrates into the clinic workflow.

Conclusion: Implementation of a CP assisted disease management system requires overcoming barriers related to affordability, device compatibility and user (both patient and healthcare team) acceptance to achieve sustainable impact on health outcomes.