Comprehensive diabetes management program for poorly controlled Hispanic type 2 patients at a community health center.

Technology and improved care coordination models can help diabetes educators and providers meet national care standards and provide culturally sensitive diabetes education that may improve diabetes outcomes. The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program (Comprehensive Diabetes Management Program, CDMP) for poorly controlled Hispanic type 2 diabetes (T2DM) patients in an urban community health center setting. Patients were randomized to the intervention condition (IC; n = 21) or an attention control condition (AC; n = 18). IC and AC conditions were compared on rates of adherence to national clinical practice guidelines (blood glucose, blood pressure, foot exam, eye exam), and levels of diabetes distress, depression, and treatment satisfaction. IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC (-1.6% ± 1.4% versus -0.6% ± 1.1%; P = .01). The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c (IC = 45%; AC = 28%), systolic blood pressure (IC = 55%; AC = 28%), eye screening (IC = 91%; AC = 78%), and foot screening, (IC = 86%; AC = 72%). Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC (P = .05 and P = .06, respectively), with no differences for depression. The CDMP intervention was more effective than an attention control condition in helping patients meet evidence-based guidelines for diabetes care.

Evolution of a web-based, prototype Personal Health Application for diabetes self-management.

Behaviors carried out by the person with diabetes (e.g., healthy eating, physical activity, judicious use of medication, glucose monitoring, coping and problem-solving, regular clinic visits, etc.) are of central importance in diabetes management. To assist with these behaviors, we developed a prototype PHA for diabetes self-management that was based on User-Centered Design principles and congruent with the anticipatory vision of Project Health Design (PHD). This article presents aspects of the prototype PHA's functionality as conceived under PHD and describes modifications to the PHA now being undertaken under new sponsorship, in response to user feedback and timing tests we have performed. In brief, the prototype Personal Health Application (PHA) receives data on the major diabetes management domains from a Personal Health Record (PHR) and analyzes and provides feedback based on clinically vetted educational content. The information is presented within "gadgets" within a portal-based website. The PHR used for the first implementation was the Common Platform developed by PHD. Key changes include a re-conceptualization of the gadgets by topic areas originally defined by the American Association of Diabetes Educators, a refocusing on low-cost approaches to diabetes monitoring and data entry, and synchronization with a new PHR, Microsoft® HealthVault™.

Combining iGoogle and personal health records to create a prototype personal health application for diabetes self-management.

OBJECTIVE: The aim of this project is to create a prototype for a personal health application (PHA) for patients (i.e., consumers) with diabetes by employing a user-centered design process. This article describes the design process for and resulting architecture, workflow, and functionality of such a PHA. MATERIALS AND METHODS: For the design process, we conducted focus groups with people who have diabetes (n = 21) to ascertain their needs for a PHA. We then developed a prototype in response to these needs, and through additional focus groups and step-by-step demonstrations for people with diabetes as well as healthcare providers, we obtained feedback about the prototype. The feedback led to changes in the PHA's presentation and function. RESULTS: Focus group participants said they wanted a tool that could give them timely, readily available information on how diabetes-related domains interact, how their behaviors affect them, and what to do next. Thus, the prototype PHA is Internet-based, retrieves data for diabetes self-management from a personal health record, displays those data using gadgets in the consumer's iGoogle page, and makes the data available to a decision-support component that provides lifestyle-oriented advice. Manipulation of the data enables consumers to anticipate the results of future actions and to see interrelationships. CONCLUSIONS: A user-centered design process resulted in a PHA that uses technology that is publicly available, employs a personal health record, and is Internet based. This PHA can provide the backbone for a decision support system that can bring together the cornerstones of diabetes self-management and integrate them into the life of the person with diabetes.

Usability test of an internet-based informatics tool for diabetes care providers: the comprehensive diabetes management program.

BACKGROUND: Research suggests Internet-based care management tools are associated with improvements in care and patient outcomes. However, although such tools change workflow, rarely is their usability addressed and reported. This article presents a usability study of an Internet-based informatics application called the Comprehensive Diabetes Management Program (CDMP), developed by content experts and technologists. Our aim is to demonstrate a process for conducting a usability study of such a tool and to report results. METHODS: We conducted the usability test with six diabetes care providers under controlled conditions. Each provider worked with the CDMP in a single session using a "think aloud" process. Providers performed standardized tasks with fictitious patient data, and we observed how they approached these tasks, documenting verbalizations and subjective ratings. The providers then completed a usability questionnaire and interviews. RESULTS: Overall, the scores on the usability questionnaire were neutral to favorable. For specific subdomains of the questionnaire, the providers' reported problems with the application's ease of use, performance, and support features, but were satisfied with its visual appeal and content. The results from the observational and interview data indicated areas for improvement, particularly in navigation and terminology. CONCLUSIONS: The usability study identified several issues for improvement, confirming the need for usability testing of Internet-based informatics applications, even those developed by experts. To our knowledge, there have been no other usability studies of an Internet-based informatics application with the functionality of the CDMP. Such studies can form the foundation for translation of Internet-based medical informatics tools into clinical practice.