Clinical Services

Oral Presentation

(CS5-02) Remote Interventions Improving Specialty Complex Care (RIISCC) for Patients with Type 2 Diabetes

Monday, April 24
10:45 AM - 11:15 AM
Location: W224 AB

Objectives
Payers continue to be concerned about the continual increase in the cost of caring for complex patients. This CMMI-funded project is focusing specifically on (all-cause) hospitalized patients with Type 2 diabetes and identifying the potential impact of active remote patient monitoring services for this population. Objectives include:
1. Describe the increasing prevalence of diabetes and its cost to the economy.
2. Provide a description of RIISCC, which is a CMMI-funded remote patient monitoring program for patients with diabetes.
3. Provide estimates of the effect of RIISCC on diabetes health outcomes and patient engagement and satisfaction.


Methods
This is a one-group pre-post study with a sample size of 552 patients with diabetes recently discharged from Nebraska Medicine. The study started in 2014. Hemoglobin A1c test is performed at baseline. The intervention consists of early and timely post hospital discharge services and incentives to promote self-management, to include 1) daily RPM for 90 days from the time the equipment is placed in the home, 2) coaching and education via weekly telephone calls (minimum) between the patient and RPM coach, 3) nutritional counseling and virtual foot exam with updated diabetes education goals with a certified diabetes educator (CDE) nurse or dietician via interactive video, 4) Diabetic retinopathy screening and consultation (if needed) via interactive video. The outcome measures are Hemoglobin A1c, Patient Activation Measure (PAM, a measure of knowledge, skills, and confidence of a patients in managing their health), and patient satisfaction. The independent variable is the pre-post intervention.

Results
Percentage of patients with A1c>9% decreased from 26 to 12 (p < 0.001). PAM increased from 61 to 68 on a 100-point scale (p < 0.001). About 96% of the patients agreed or strongly agreed with the statement “I would recommend this program to a friend.”

Conclusion
Remote patient monitoring programs are promising in enhancing the health of patients with Type 2 diabetes and their activation in managing their disease.

Disclaimer:
The project described was supported by Grant Number 1C1CMS331344 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor.

Robert Schwab

Assistant Professor/Project Medical Director
University of Nebraska Medical Center

Robert Schwab, MD is a board certified internist with a clinical practice at Boy's Town National Research Hospital in Omaha, NE. He also works in the Vice Chancellor Research Office at the University of Nebraska Medical Center, where he serves as the medical director for the Practice-based Research Network, examining health disparities in rural Nebraska. Since 2014, Dr. Schwab has also served as the medical director for the Remote Interventions Improving Specialty Complex Care (RIISCC) program, which is a 3-year CMS-CMMI funded grant project. This project evaluates the efficacy of remote patient monitoring for patients with diabetes mellitus having a recent hospitalization. Dr. Schwab has been practicing general Internal Medicine for the past twenty years.

Presentation(s):

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Geri M. Tyson

Telehealth Program Manager; Clinic Manager-Remote Patient Monitoring Grant
Nebraska Medicine

Geri has been a registered nurse for over 13 years and has a MSN - Executive Degree. Geri has experience as a nurse leader, value analysis coordinator, clinical quality lead and Telehealth program manager. She is also the Clinic manager of the Remote Patient Monitoring Team. Geri remains current in nursing practice by remaining a bedside nurse in the Neonatal Intensive Care Unit.

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(CS5-02) Remote Interventions Improving Specialty Complex Care (RIISCC) for Patients with Type 2 Diabetes



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