Diabetes is a major public health problem that disproportionately affects vulnerable populations, including racial and ethnic minorities, those with lower socioeconomic status and individuals with low health literacy. We propose to evaluate the fidelity of implementation of an innovative health information technology (Health IT) intervention for patients with chronic disease, the Automated Telephone Support Program (ATSM) developed to reach vulnerable populations with diabetes. We have developed and studied ATSM in efficacy and effectiveness trials, finding ATSM is associated with improvements in multiple diabetes-related outcomes. ATSM has received national attention, and is aligned with the national health care reform policy focus on determining how best to deploy health IT to deliver effective health care at low cost to large sectors of the US population. Based on the growing interest, it is critical to examine factors associated with ATSM implementation that may impact its wider adoption. ATSM is a complex intervention that employs phone technology to provide patient surveillance and education and to prioritize further telephone care management efforts for those most in need. ATSM innovation relates to its: (1) integration of electronic information into ongoing clinical care, to improve quality and efficiency of care delivery;and (2) effective health communication tailoring, by care managers over the telephone, for the provision of literacy or language-tailored support counseling. We have provided ATSM in a 'real world'implementation study, with AHRQ funding, in partnership with a regional health plan, the San Francisco Health Plan (SFHP). We propose in this R03 to examine the fidelity of the intervention's implementation and examine adaptations made to increase its adoption. Specifically, we will use a modified Conceptual Framework for Evaluating Implementation Fidelity to organize essential ATSM delivery components. We will use this framework to structure a detailed data-based assessment of fidelity measures (e.g. frequency, content, and duration of ATSM delivery), and measures related to proposed moderating factors to ATSM delivery (e.g. representativeness of participants vs. non- participants, and quality of care management calls). We will work with SFHP to analyze the extensive data collected for the ATSM program, and to develop a User Guide that may inform other organizations considering scaling up similar health IT interventions. There is scant literature on how to adapt complex health IT interventions, such as ATSM, to local health systems needs. Examining the fidelity of implementation of such a program, describing adaptations that were made to improve adoption, and examining how adaptations and moderators will provide relevant necessary information. These findings can move forward the field of diabetes care, provide timely information on processes of adoption critical to implementation planning, and serve as a model for evaluating other complex health IT interventions. This R03 serves as an essential component to developing an evidence base to inform the scaling up health IT innovations such as ATSM.

Public Health Relevance

Diabetes is a major public health problem that disproportionately affects vulnerable populations, including racial and ethnic minorities, those with lower socioeconomic status and individuals with low health literacy. We have developed and found successful in efficacy studies, a health IT innovation that is tailored to patient language and literacy needs, and are completing a study of its effectiveness in a 'real world'translational research trial, with a local Medicaid managed care plan. We propose in this R03 to examine the fidelity of the intervention's implementation and examine adaptations made to increase adoption. This information can inform efforts underway in national health reform, to scale up health IT interventions to off-set growing chronic disease care costs.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Small Research Grants (R03)
Project #
1R03HS020684-01
Application #
8173500
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Nunley, Angela
Project Start
2011-07-11
Project End
2012-12-31
Budget Start
2011-07-11
Budget End
2012-12-31
Support Year
1
Fiscal Year
2011
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
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Ratanawongsa, Neda; Karter, Andrew J; Quan, Judy et al. (2015) Reach and Validity of an Objective Medication Adherence Measure Among Safety Net Health Plan Members with Diabetes: A Cross-Sectional Study. J Manag Care Spec Pharm 21:688-98
Quan, Judy; Lee, Alexandra K; Handley, Margaret A et al. (2015) Automated Telephone Self-Management Support for Diabetes in a Low-Income Health Plan: A Health Care Utilization and Cost Analysis. Popul Health Manag 18:412-20
Ratanawongsa, Neda; Handley, Margaret A; Sarkar, Urmimala et al. (2014) Diabetes health information technology innovation to improve quality of life for health plan members in urban safety net. J Ambul Care Manage 37:127-37
Lyles, Courtney R; Schillinger, Dean; Lopez, Andrea et al. (2013) Safety events during an automated telephone self-management support intervention. J Diabetes Sci Technol 7:596-601
Ratanawongsa, Neda; Handley, Margaret A; Quan, Judy et al. (2012) Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol. BMC Health Serv Res 12:22