Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 18, 2018
Open Peer Review Period: May 19, 2018 - Jul 14, 2018
Date Accepted: Nov 25, 2018
(closed for review but you can still tweet)
Person-Centered, Technology Enhanced Care Model For Managing Chronic Conditions: Development and Implementation
ABSTRACT
Background:
Caring for individuals with chronic conditions is labor intensive, requiring ongoing appointments, treatments, and support. The growing number of individuals with chronic conditions makes this current support model unsustainably burdensome on health care systems globally. Mobile health (mHealth) technologies are increasingly being used throughout health care to facilitate communication, track disease, and provide educational support to patients. Such technologies show promise, yet they are not being utilized to their full extent within US health care systems.
Objective:
The purpose of this study was to examine the utilization of staff and costs of a remote monitoring care model in persons with and without a chronic condition.
Methods:
At Dartmouth-Hitchcock Health, 2,894 employees volunteered to monitor their health, transmit data for analysis, and communicate digitally with a care team. Volunteers received Bluetooth-connected consumer-grade devices that were paired to a smartphone application that facilitated digital communication with nursing and health behavior change staff. Health data were collected, automatically analyzed, and generated behavioral support communications based on those analyses. Care support staff were automatically alerted according to purpose-developed algorithms. In a subgroup of participants and matched controls, we used difference-in-difference techniques to examine changes in per-capita expenditures.
Results:
Participants averaged 41 years of age; 73% (n = 2,104) were female and 13% (n = 376) had at least one chronic condition. On average, each month, participants submitted 23 vital sign measurements, engaged in 1.96 conversations, and received 0.25 automated messages. Persons with chronic conditions accounted for 40% of all staff conversations, with higher per-capita conversation rates for all shifts compared to those without chronic conditions (P<.001). Additionally, persons with chronic conditions engaged nursing staff more than those without chronic conditions (1.40 & 0.19 per-capita conversations, respectively, P<.001). When compared to the same period in the prior year, per-capita healthcare expenditures for persons with chronic conditions dropped by 15% (P=.06) more than did those for matched controls.
Conclusions:
The technology-based chronic condition management care model was frequently used and demonstrated the potential for cost savings among participants with chronic conditions. While further studies are necessary, this model appears to be a promising solution to efficiently provide patients with personalized care, when and where they need it.
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.