Use of Online Personalized Health Record System to Promote Self-Management of Diabetes

Palo Alto Medical Foundation415 enrolled

Overview

Diabetes is a major, growing, and costly chronic disease in the U.S., and implementation of recommended diabetes care remains poor, not merely suboptimal, and varied for a sizable proportion of Americans with diabetes. To further reduce the treatment and adherence gaps in diabetes care, the researchers propose to evaluate a Customized, Continuous Care Management (CCCM) program that actively supports a partnership between the patient and his/her multidisciplinary care management (CM) team using an online disease management (ODM) system, which is integrated with a comprehensive electronic health record (EHR) system that includes a personal health record and secure patient-clinician messaging capabilities. The CCCM program builds upon CM strategies proven effective in past studies and creates an ODM system that is built upon and fully integrated with a leading, commercially available EHR product - providing a blueprint for instituting customized, continuous care management for many different chronic conditions in a range of ambulatory care settings.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Enrollment

415

Conditions

Diabetes Mellitus

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * \>= 18 years of age * Have a designated Palo Alto Medical Foundation Primary Care Provider (PCP) * Seen in primary or specialty care at the Palo Alto Division at least once in the preceding 24 months * Diagnosis of diabetes * Baseline A1C \>= 7.5% Exclusion Criteria: * Initial diagnosis of diabetes within the last 12 months * Diagnosis of Type 1 diabetes * Inability to speak and read in English * Lack of regular access to a computer with Internet and email capabilities * Unwilling to perform any self-monitoring at home, including blood glucose and blood pressure% * Pregnant, planning to become pregnant, or lactating * Currently enrolled in a care management program at Palo Alto Medical Foundation or elsewhere * PCP determination that the study is inappropriate or unsafe for the patient * Investigator discretion for clinical safety or protocol adherence reasons

Locations (6)

PAMF Palo Alto Health Care Division

Fremont, California, United States

PAMF Palo Alto Health Care Division

Los Altos, California, United States

PAMF Camino Region

Mountain View, California, United States

PAMF Palo Alto Health Care Division

Palo Alto, California, United States

PAMF Palo Alto Health Care Division

Redwood City, California, United States

PAMF Santa Cruz Medical Clinic

Santa Cruz, California, United States