Introduction and Objective: Comprehensive telehealth improves control of refractory chronic diseases in integrated health systems, but has seldom been implemented in fee-for-service (FFS) systems. We examined the use of comprehensive telehealth for uncontrolled T2D and hypertension in a FFS environment.Methods: This randomized effectiveness-implementation trial compared two 12-month mobile monitoring-enabled telehealth interventions: 1) a self-management program; and 2) comprehensive, nurse-delivered care incorporating self-management support and pharmacist-guided medication management. Both programs leveraged a novel platform that used existing IT resources for automated integration of patient data into the Epic-based EHR. Eligible patients were from 6 Primary Care and Endocrinology clinics, had HbA1c ≥8.0 % for ≥6 months, and had uncontrolled BP. Linear mixed models examined between arm differences in HbA1c/BP change from 0 to 12 months. Consolidated Framework for Implementation Research-guided implementation analyses evaluated program fidelity and qualitative data.Results: The randomization goal (N=220) was met in June 2023; retention was 82% at 12 months. The cohort was majority female (64%) and Black (68%); at baseline, mean age was 54.5, HbA1c 9.81%, and BP 135/81. Estimated mean HbA1c at 12 months was 9.02% with self-management and 8.68% with comprehensive telehealth (between group difference -0.34, 95% CI -0.99, 0.31, p=0.31). No significant between group BP difference was seen. Key IT, patient, and staff related implementation barriers were identified; program fidelity was generally acceptable, but variability associated with social drivers of health was noted.Conclusion: This work highlights challenges to implementation of comprehensive telehealth in FFS environments that are not ideally designed for such care. Our implementation findings suggest strategies to support future delivery of comprehensive telehealth in FFS systems.
M.J. Crowley: None. Q. Yang: None. D.J. Hatch: None. A. Lewinski: None. H.B. Bosworth: Research Support; ESPERION Therapeutics, Inc., Sanofi, Pfizer Inc, Novo Nordisk, Improved Patient Outcomes, Otsuka America Pharmaceutical, Inc, elton john foundation, walmart, Boehringer-Ingelheim. R. Chatterjee Montgomery: None. G. Pennington: None. D.M. Matters: None. D. Lee: None. H. Canupp: None. P.B. Gregory: None. C.A. Roberson: None. B.H. Smith: None. J. German: None. R.J. Shaw: None.
National Institutes of Health (1R01NR019594)
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