Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis

• Published in: PLoS medicine Vol. 17; no. 10; p. e1003367
• Main Authors: Lim, Lee-Ling, Lau, Eric S H, Ozaki, Risa, Chung, Harriet, Fu, Amy W C, Chan, Wendy, Kong, Alice P S, Ma, Ronald C W, So, Wing-Yee, Chow, Elaine, Cheung, Kitty K T, Yau, Tiffany, Chow, C C, Lau, Vanessa, Yue, Rebecca, Ng, Shek, Zee, Benny, Goggins, William, Oldenburg, Brian, Clarke, Philip M, Lau, Maggie, Wong, Rebecca, Tsang, C C, Gregg, Edward W, Wu, Hongjiang, Tong, Peter C Y, Ko, Gary T C, Luk, Andrea O Y, Chan, Juliana C N
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02-10-2020; Public Library of Science (PLoS)
• Subjects: Adult; Care and treatment; Charitable foundations; Clinical outcomes; Cohort analysis; Cohort Studies; Communications technology; Data collection; Decision making; Delivery of Health Care, Integrated - statistics & numerical data; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes therapy; Education; Electronic medical records; Empowerment; Expenditures; Female; Health aspects; Hong Kong - epidemiology; Hospitalization; Hospitals; Humans; Information technology; Insurance coverage; Integrated delivery networks; Male; Medicine and Health Sciences; Methods; Middle Aged; Nurses; Patient outcomes; Patients; People and Places; Physicians; Primary care; Program Evaluation; Proportional Hazards Models; Quality control; Registries; Retrospective Studies; Risk Factors; Self Care - methods; Technology application; Treatment Outcome; Type 2 diabetes; Hong Kong; Hong Kong China; United Kingdom > UK; Asia; United States > US
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1003367

Diabetes outcomes are influenced by host factors, settings, and care processes. We examined the association of data-driven integrated care assisted by information and communications technology (ICT) with clinical outcomes in type 2 diabetes in public and private healthcare settings.
The web-based Joint Asia Diabetes Evaluation (JADE) platform provides a protocol to guide data collection for issuing a personalized JADE report including risk categories (1-4, low-high), 5-year probabilities of cardiovascular-renal events, and trends and targets of 4 risk factors with tailored decision support. The JADE program is a prospective cohort study implemented in a naturalistic environment where patients underwent nurse-led structured evaluation (blood/urine/eye/feet) in public and private outpatient clinics and diabetes centers in Hong Kong. We retrospectively analyzed the data of 16,624 Han Chinese patients with type 2 diabetes who were enrolled in 2007-2015. In the public setting, the non-JADE group (n = 3,587) underwent structured evaluation for risk factors and complications only, while the JADE (n = 9,601) group received a JADE report with group empowerment by nurses. In a community-based, nurse-led, university-affiliated diabetes center (UDC), the JADE-Personalized (JADE-P) group (n = 3,436) received a JADE report, personalized empowerment, and annual telephone reminder for reevaluation and engagement. The primary composite outcome was time to the first occurrence of cardiovascular-renal diseases, all-site cancer, and/or death, based on hospitalization data censored on 30 June 2017. During 94,311 person-years of follow-up in 2007-2017, 7,779 primary events occurred. Compared with the JADE group (136.22 cases per 1,000 patient-years [95% CI 132.35-140.18]), the non-JADE group had higher (145.32 [95% CI 138.68-152.20]; P = 0.020) while the JADE-P group had lower event rates (70.94 [95% CI 67.12-74.91]; P < 0.001). The adjusted hazard ratios (aHRs) for the primary composite outcome were 1.22 (95% CI 1.15-1.30) and 0.70 (95% CI 0.66-0.75), respectively, independent of risk profiles, education levels, drug usage, self-care, and comorbidities at baseline. We reported consistent results in propensity-score-matched analyses and after accounting for loss to follow-up. Potential limitations include its nonrandomized design that precludes causal inference, residual confounding, and participation bias.
ICT-assisted integrated care was associated with a reduction in clinical events, including death in type 2 diabetes in public and private healthcare settings.