Use of an interactive, telephone-based self-management support program to identify adverse events among ambulatory diabetes patients.
BACKGROUND
There is growing interest in the use of interactive telephone technology to support chronic disease management. We used the implementation of an automated telephone self-management support program for diabetes patients as an opportunity to monitor patient safety.


METHODS
We identified adverse and potential adverse events among a diverse group of diabetes patients who participated in an automated telephone health-IT self-management program via weekly interactions augmented by targeted nurse follow-up. We defined an adverse event (AE) as an injury that results from either medical management or patient self-management, and a potential adverse event (PotAE) as an unsafe state likely to lead to an event if it persists without intervention. We distinguished between incident, or new, and prevalent, or ongoing, events. We conducted a medical record review and present summary results for event characteristics including detection trigger, preventability, potential for amelioration, and primary care provider awareness.


RESULTS
Among the 111 patients, we identified 111 AEs and 153 PotAEs. Eleven percent of completed calls detected an event. Events were most frequently detected through health IT-facilitated triggers (158, 59%), followed by nurse elicitation (80, 30%), and patient callback requests (28, 11%). We detected more prevalent (68%) than incident (32%) events. The majority of events (93%) were categorized as preventable or ameliorable. Primary care providers were aware of only 13% of incident and 60% of prevalent events.


CONCLUSIONS
Surveillance via a telephone-based, health IT-facilitated self-management support program can detect AEs and PotAEs. Events detected were frequently unknown to primary providers, and the majority were preventable or ameliorable, suggesting that this between-visit surveillance, with appropriate system-level intervention, can improve patient safety for chronic disease patients.
Sarkar
Urmimala
U
Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA 94143-1211, USA. usarkar@medicine.ucsf.edu
Handley
Margaret A
MA
Gupta
Reena
R
Tang
Audrey
A
Murphy
Elizabeth
E
Seligman
Hilary K
HK
Shojania
Kaveh G
KG
Schillinger
Dean
D
D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D007003:Hypoglycemia / Q000175:diagnosis*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D009726:Nurses; D012189:Retrospective Studies; D012646:Self Administration / Q000009:adverse effects*; D017216:Telemedicine; D013689:Telephone
D007004:Hypoglycemic Agents