In Mississippi, Telehealth Makes a Measurable Difference in Diabetes Care

For decades, staying on top of those with type 2 diabetes (T2D) in the Mississippi Delta region seemed an unsolvable problem. Poverty and limited resources meant just reaching patients was a challenge, much less getting them to stay on a regimen to keep glycated hemoglobin in check.

Today, however, a state that historically has had little to brag about when it comes to healthcare is leading the nation in managing diabetes through telehealth, which it is using to get to patients earlier, drive behavioral change, and keep patients out of the hospital. The Diabetes Telehealth Network, which began in 2014, is part of a larger commitment to remote delivery of health services through the Center for Telehealth at the University of Mississippi Medical Center (UMMC), located in the state capital of Jackson. The state’s former US senator, Trent Lott, is now a lobbyist and proponent of the technology.¹ (CMS has continued to update rules to expand Medicare reimbursement for telehealth, although advocates say it would enjoy even greater use with additional changes.²)

Through a partnership with GE Healthcare and C-Spire,³ UMMC began a research project in Sunflower County, a poor area of the Mississippi Delta best known for being home to the state penitentiary. US Census Bureau 2015 data on the county listed the population at 72.9% African American; of those under age 65, 10.1% had a disability and 21.3% had no health insurance. The median household income is $27,941, and 34.8% of the residents live in poverty.⁴

Rates of T2D here are 12%, and 293 people died of complications of the disease in 2010.³ To change that, in late 2014, UMMC started toward a goal of enrolling 200 patients in a study, with each patient receiving 18 months of remote care. This involves teaching patients about their diabetes and using tablet technology to check in with them to monitor their disease.

According to Michael Adcock, administrator at the Center for Telehealth, each enrollee receives a remote patient-monitoring kit that includes an iPad Mini and peripherals, such as a blood glucose meter, that allow patients to manage several types of chronic conditions, including diabetes/hypertension, chronic obstructive pulmonary disease, and congestive heart failure. Daily health lessons are delivered to the patient on the iPad, which is set with an alarm as a reminder to start the lesson.

“Whatever time you want it, you let us know when you want the alarm,” Adcock said in an interview with Evidence-Based Diabetes Management. The lessons are interactive: patients have to answer questions through a “decision tree.”

“It asks, ‘Did you take your medication?’ but if the answer is negative, it asks, ‘Why not?’” Adcock explained. If a prescription hasn’t been filled, there’s a contact to a pharmacy. If there are transportation issues, UMMC tries to address those. Most of all, the system allows for intervention at the first sign of trouble: if UMMC can’t reach a patient who typically logs in for a lesson, the staff reach a designated alternate contact person.

Alhough unpublished thus far, Adcock said the early results are attracting notice.. “Of the first 100 patients we enrolled, we had zero readmissions,” he said. “There were zero ER visits for uncontrolled diabetes.”

At the time of the EBDM interview, the study had enrolled 141 patients; with the first 100 patients, the project uncovered 18 cases of diabetic retinopathy that would not have been found otherwise, Adcock said. Reimbursement for telehealth is not an issue, he said, because the Mississippi legislature requires coverage. The program is creating significant cost savings because in addition to keeping patients out of the hospital, it is also eliminating travel costs to the state medical school for specialized care.

“We’ve saved 10,000 miles of travel for our first 100 patients,” Adcock said.

Beyond improved clinical outcomes, reduced travel, and avoided readmissions, there are the intangibles of empowering patients to take control of their own care, as well. “Daily interaction with the tablet has made a huge difference,” according to Adcock. Getting day-to-day reinforcement about positive changes—and coaching for confessions like “I just ate a piece of pie”—help patients slowly change a lifetime of habits.

Those who had expected to see themselves slowly decline with diabetes, to lose toes or feet the way older relatives had, suddenly awaken to the idea that things don’t have to be that way. “It’s truly life-altering,” Adcock said. “They had never really been engaged in technology.”

References

1. Pittman D. Mississippi emerges as telemedicine leader. Politico website. http://www.politico.com/story/2015/02/mississippi-telemedicine-115515. Published February 26, 2015. Accessed February 28, 2016.

2. Drobac K. Telehealth: an important tool in achieving the goals of the ACO program and why restrictions should be lifted in the final ACO rule. Am J Account Care. 2014;2(4):24-25.

3. Extending access to quality care in the Mississippi Delta: Diabetes Telehealth Network sees early patient success. GE Healthcare newsroom. http://newsroom.gehealthcare.com/extending-access-quality-care-mississippi-delta-diabetes-telehealth-network/. Published December 4, 2014. Accessed February 28, 2016.

4. Sunflower County, Mississippi. 2015. US Census Bureau website. http://www.census.gov/quickfacts/table/PST045215/28133. Accessed March 2, 2016.