Using Health Information Technology (HIT) to Improve Ambulatory Chronic Disease Care: Smart Device Substudy

To evaluate the effectiveness of short-term targeted use of remote data transmission from in-home devices (blood glucose meter/blood pressure machine) to the clinic on treatment outcomes in patients with diabetes who have out of range blood glucose (BG) or systolic blood pressure (BP) measurements. Increased frequency of data transmission will provide the provider with "real time" data in order to make more timely adjustments in the treatment plan, resulting in improved glycemic control as measured by A1c values and hypertension as measured by systolic blood pressure (SBP).

Subjects will be recruited from Family & Community Medicine (FCM) and General Internal Medicine (GIM) clinics. We will randomly select patients from physicians with a minimum number of 5 eligible patients from the performance measurement list (A1c>=8% or SBP>130) to approach for the study. Patients who agree to enroll will be randomized to experimental and control using a block randomization approach stratified by age increments (18-40; 41-55; 56-70; 71+). Subjects will be randomized using prepared sealed envelopes. A total of 200 subjects (100 intervention subjects and 100 control subjects) will be enrolled over a period of one year. We will attempt to enroll equal numbers of FCM and GIM subjects.

For all subjects, baseline data will be collected from the patient, including demographic data (age, gender, race, and years of formal education), payor status (private pay, insurance, Medicaid), number of co-morbid conditions, baseline blood pressure, and length of time diagnosed with diabetes (DM) and hypertension.

Intervention patients will be instructed to test their BP and BG according to a minimum protocol of at least once daily and upload this clinical data at least every other day for the 3-month study duration, but this frequency could be further tailored by their provider, i.e., more than once daily. At least 2 of these BG readings each week should be fasting levels. Patient training will emphasize that this system is not an emergency response system, i.e., critical values should be treated in the usual manner.

Control group patients (those who do not receive the device) will be asked to test their BP and BG at least once daily (in the same fashion as the intervention group). They will be instructed to bring these readings to their clinic visits, and again at the end of the study. We will collect these readings.