Management of Type 1 diabetes requires vigilant monitoring by patients who often encounter numerous barriers that can impede proper management. Barriers can include educational, psychosocial, and support issues. Polaris Health Directions, a small business, and University of Pennsylvania School of Nursing have partnered to develop the Technology-enabled Type 1 Diabetes Education and Support (T1DES) system that will assist and support diabetes management by providing: (1) an automated, web-based management assessment (skills, knowledge, barriers, routine screenings for complications) that can be completed on any internet-connected personal or tablet computer; (2) real time patient report with tailored educational materials and support; (3) real time 1-page clinician report that highlights psychosocial issues, barriers to management, and need for routine screening; (4) e-learning tools (web-based learning modules and webinars); (5) enhanced messaging systems (EMS; i.e., automated text messaging and emails) to send patient reminders and to support diabetes management between office visits, and (6) the capability to be integrated into electronic health records (EHR) via HL7 interface and automate referrals to mental health providers, social workers, and diabetes specialists. In Phase I, a pilot study will be conducted to demonstrate the feasibility and potential of T1DES to support diabetes management through e-assessment, e-learning and e-messaging. Specific Aim 1: Develop the T1DES prototype based on end-user interviews (patient, family members, diabetes providers); finalize educational modules and e-messaging content; design assessment and reports; write and test T1DES software; train clinicians to use the system, and conduct a Field Test at the Diabetes Center for Children at Children's Hospital of Philadelphia (Months 1-6). Specific Aim 2: Conduct a Pilot Study and evaluate the acceptance of the system by end-users (Months 6-12).The Pilot Study will enroll 40 patients (13-18 years old) and 40 family members involved in the patient's diabetes management. Patients will complete the assessment, set goals to achieve before their next appointment, and receive a tailored, educational feedback report that will be reviewed with a diabetes provider. The patient will then receive e-messages daily for 3-months based on the diabetes management goals they have selected. Additionally, family members and patients will receive appointment reminders and have access to online e-learning tools (educational modules and webinars).Three months after enrolling in the study, participants will be asked to complete a satisfaction survey regarding the educational and supportive benefits of the T1DES system, readability, and ease of use that will help inform further product development. In Phase II, a multi-site randomized controlled trial will be conducted to examine T1DES impact on HbA1C, management skills, knowledge, and barriers, medical outcomes, and healthcare utilization over a one year period. Other Phase II goals will include: integration with EHR; development of a web-based multimedia training for clinicians; and interactive provider-patient text and voice messaging.
Public Health Relevance Statement: Public Health Relevance: T1DES will make substantial contributions to public health and to diabetes research. It will improve management for Type 1 diabetes, reducing both the costs and suffering associated with poor diabetes control. It can be readily adapted for use with Type 2 diabetes. It will contribute to knowledge regarding the feasibility of using electronic messaging systems (EMS) and e-learning tools to improve diabetes self-management across a diverse sample of youths, and identify race/ethnicity and gender preferences and satisfaction with EMS and e-learning tools.
Project Terms: 18 year old; Adolescence; Adolescent; Adult; Affect; aged; Appointment; base; Behavior; Behavioral; Blindness; Blood Glucose; Businesses; Caring; Child; Chronic Disease; Clinical; clinical practice; Complications of Diabetes Mellitus; Computer software; Computers; Control Groups; coping; cost; Data; design; Development; diabetes control; diabetes education; diabetes management; Diabetes Mellitus; Eating; Educational Materials; Effectiveness; Electronic Health Record; Electronic Mail; Electronics; Enrollment; Ethnicity aspects; Family; Family member; Feedback; Focus Groups; gender preference; Glucose; Goals; Health; health care service utilization; Health Personnel; Heart Diseases; improved; innovation; Insulin-Dependent Diabetes Mellitus; Internet; Interview; Kidney Failure; Knowledge; Learning; Life; limb amputation; Lower Extremity; Managed Care; Medical; medical complication; member; Mental Health; Monitor; Multimedia; Non-Insulin-Dependent Diabetes Mellitus; Office Visits; Online Systems; Outcome; Participant; Patient Monitoring; Patients; Pediatric Hospitals; Pennsylvania; Phase; Philadelphia; Physical activity; Pilot Projects; primary outcome; product development; programs; prototype; Provider; psychosocial; Psychosocial Assessment and Care; Psychosocial Influences; public health medicine (field); public health relevance; Race; Randomized Controlled Trials; Readability; Recruitment Activity; Reporting; Research; response; Sampling; satisfaction; School Nursing; screening; Self Care; Self Management; Site; skills; Social Workers; Software Design; Specialist; stroke; Support Groups; Support System; Surveys; System; Tablets; Technology; technology development; Testing; Text; Time; tool; Training; treatment as usual; Universities; Voice; Work; Writing; Youth
