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Impact of Integrated Patient-Facing Health IT Tools on Quality and Resource Use for Patients with Diabetes

Award Number: R01DK085070
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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SUMMARY This renewal study will examine how use of patient-facing digital health technologies impacts quality and resource use for patients with diabetes. Using a 13 year study period (2007-2019), we exploit the staggered implementation of mobile applications, web-based wellness programs, and patient-provider video-visits between 2008-2014, among a large population of over 200,000 patients with diabetes (ongoing or new diagnoses). The integrated delivery system setting provides comprehensive capture of diagnostic and treatment data (including medications, lab results and imaging) across all of a patient’s clinicians (primary care and specialists) in inpatient and outpatient settings, and make integrated data available to patients through the portal mobile applications. We were successful in our original study examining the impact of clinician-facing electronic health records (EHRs), finding associations with improved diabetes care quality (increases in guideline-recommended testing and treatment), and clinical outcomes (improved blood sugar and lipid control, reductions in emergency room visits and hospitalizations). This renewal proposal extends this line of inquiry to include novel patient-facing technologies. All of the technologies we will examine are well-integrated with patients’ ongoing health care providers and broader clinical EHR, in contrast with the growing number of health applications available for patient download that are a data dead-end, leading to more fragmented care. The main proposed study predictor is patient technology use (mobile applications, web-based wellness programs, and patient-provider video-visits). In Aim 1, we will examine whether use of patient-facing technologies improves quality of care in patients with diabetes, specifically examining guideline-adherent prescription drug use and laboratory monitoring, drug adherence, and physiologic disease control (lab values) for diabetes and for any of four other comorbid chronic conditions (Asthma, CAD, CHF, and HTN). In Aim 2, we will examine resource use outcome measures including outpatient visits, emergency department visits, and non-elective hospitalizations. Using marginal structural models, we will test the hypotheses that patient technology use is associated with improved quality and lower in-person visit rates, while accounting for patient engagement, recent changes in health status, case-mix, cost-sharing for in-person visits, and patient demographic and socio-economic characteristics. The proposed study is likely to be the largest rigorous study of the impact of patient-facing technology use on health outcomes, including patient-provider video visit telehealth. By examining an early adopter of the technologies, and patients with diabetes who have complex clinical and self- management needs, this project has the potential to provide timely evidence to inform emerging telehealth and mhealth policies, technology adoption decisions, and real world use by clinicians and patients.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = -$4,073 )
2025	2019	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	8	10/1/2024	NON-COMPETING CONTINUATION	-$4,073
														Subtotal = -$4,073

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2019	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	8	8/23/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $0 )
2022	2019	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	8	8/18/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $0 )
2021	2019	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	8	8/26/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2019 ( Subtotal = $580,000 )
2019	2019	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	8	8/14/2019	NON-COMPETING CONTINUATION	$580,000
														Subtotal = $580,000

Issue Date FY: 2018 ( Subtotal = $580,000 )
2018	2018	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	7	7/26/2018	NON-COMPETING CONTINUATION	$580,000
														Subtotal = $580,000

Issue Date FY: 2017 ( Subtotal = $580,000 )
2017	2017	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	6	8/18/2017	NON-COMPETING CONTINUATION	$580,000
2017	2016	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	5	2/24/2017	COMPETING CONTINUATION	$142,705
2017	2013	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	2/24/2017	NON-COMPETING CONTINUATION	-$142,705
														Subtotal = $580,000

Issue Date FY: 2016 ( Subtotal = $580,000 )
2016	2016	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	5	9/16/2016	COMPETING CONTINUATION	$580,000
2016	2013	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	946123433	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	4	9/12/2016	NON-COMPETING CONTINUATION	$0
2016	2013	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	946123433	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	4/5/2016	NON-COMPETING CONTINUATION	$0
														Subtotal = $580,000

Issue Date FY: 2015 ( Subtotal = $0 )
2015	2013	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	3/18/2015	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2013 ( Subtotal = $498,977 )
2013	2013	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	3/22/2013	NON-COMPETING CONTINUATION	$465,366
2013	2013	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	4	5/23/2013	NON-COMPETING CONTINUATION	$33,611
														Subtotal = $498,977

Issue Date FY: 2012 ( Subtotal = $517,717 )
2012	2012	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	3/23/2012	NON-COMPETING CONTINUATION	$517,717
														Subtotal = $517,717

Issue Date FY: 2011 ( Subtotal = $518,228 )
2011	2011	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	3/24/2011	NON-COMPETING CONTINUATION	$485,235
2011	2011	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	2	5/23/2011	NON-COMPETING CONTINUATION	$32,993
														Subtotal = $518,228

Issue Date FY: 2010 ( Subtotal = $521,215 )
2010	2010	KAISER FOUNDATION RESEARCH INSTITUTE	1800 HARRISON, 16TH FLOOR	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	4/5/2010	NEW	$521,215
														Subtotal = $521,215

Grand Total All Awards = $4,372,064

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Impact of Integrated Patient-Facing Health IT Tools on Quality and Resource Use for Patients with Diabetes

Award Number: R01DK085070

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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