Using Mobile Health to Support the Chronic Care Model : Developing an Institutional Initiative

• Published in: International journal of telemedicine and applications Vol. 2012; no. 2012; pp. 1 - 8
• Main Authors: Nundy, Shantanu, Dick, Jonathan J., Goddu, Anna P., Hogan, Patrick, Lu, Chen-Yuan E., Solomon, Marla C., Bussie, Arnell, Chin, Marshall H., Peek, Monica E.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Puplishing Corporation 01-01-2012; Hindawi Publishing Corporation; Hindawi Limited
• Subjects: African Americans; Ambulatory care; Availability; Cellular telephones; Demand; Diabetes; Disease management; Health; Health care access; Health services; Hospitals; Internal medicine; Low income groups; Medicine; Mortality; Nurses; Patients; Physicians; Pilots; Recognition; Texts; Chicago Illinois
• ISSN: 1687-6415; 1687-6423
• DOI: 10.1155/2012/871925

Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.