Structure, process, and outcomes of care in a telemonitoring program for patients with type 2 diabetes

Abstract

Background

Using Donabedian’s structure-process-outcomes (SPO) framework, this descriptive, exploratory study examined the structure of a telemonitoring program in a population of patients with type 2 diabetes (T2D), the process of nurse–patient telephonic interactions, and patients’ clinical outcomes.

Methods

Secondary data analysis was conducted using data from 581 patients who participated in a home telemonitoring program for 12 months. Three point-biserial and six Pearson correlations were estimated to determine how patient demographics related to clinical characteristics. Mixed model regressions were conducted predicting hemoglobin A_1c (HbA_1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels at 6, 9, and 12 months based on the frequency of contact in the earlier 3 months. Analysis of variances were conducted to assess if the frequency of contact was significantly different by change in HbA_1c levels from 3 to 6, 6 to 9, and 9 to 12 months.

Results

Significant negative correlations were found between age and HbA_1c (r=−0.10, P=0.015) and DBP (r=−0.16, P<0.001), a significant positive correlation was found between age and SBP (r=0.15, P=0.001). A significant correlation was found between sex and DBP (r_pb=−0.11, P=0.015); female participants had lower DBP levels than males. Frequency of contact was not related to the change in clinical outcomes. However, the frequency of contact for the time period 3 to 6 months was associated with change in HbA_1c for the 6- to 9- month period and frequency of contact during the 6- to 9- month period was associated with change in HbA_1c from 9 to 12 months.

Conclusion

Examination of the SPO measures in the telemonitoring environment assisted in understanding the effectiveness of this type of unique intervention and the need for further in-depth exploration of self-management techniques among individuals with T2D.

Keywords:

• telemonitoring
• type 2 diabetes
• telephonic care
• telehealth
• telecare

Acknowledgments

The authors would like to acknowledge Dr Dunn, Ann Frisch, and Susan Lehrer for their invaluable support in this research.

Disclosure

The authors report no conflicts of interest in this work.