title: Engagement with automated patient monitoring and self-management support calls: experience with a thousand chronically ill patients.
abstract: BACKGROUND
  Patient self-care support via Interactive Voice Response (IVR) can improve disease management. However, little is known about the factors affecting program engagement.
  
  
  METHODS
  We compiled data on IVR program engagement for 1173 patients with: heart failure, depression, diabetes, or cancer who were followed for 28,962 person-weeks. Patients in programs for diabetes or depression (N=727) had the option of participating along with an informal caregiver who received electronic feedback based on the patient's IVR assessments. Analyses focused on factors associated with completing weekly IVR calls.
  
  
  RESULTS
  Patients were on average 61 years old, 37% had at most a high school education, and 48% reported incomes of ≤$30,000. Among patients given the option of participating with an informal caregiver, 65% chose to do so. Patients completed 83% of attempted IVR assessments, with rates higher for heart failure (90%) and cancer programs (90%) than for the diabetes (81%) or depression programs (71%) (P<0.001). Among patients in diabetes or depression programs, those opting to have feedback provided to an informal caregiver were more likely to complete assessments [adjusted odds ratio, 1.37; 95% confidence interval, 1.07-1.77]. Older patients had higher call completion rates, even among patients aged 75 years and older. Missed clinic appointments, prior hospitalizations, depression program participation, and poorer mental health were associated with lower completion rates.
  
  
  CONCLUSIONS
  Patients with a variety of chronic conditions will complete IVR self-care support calls regularly. Risk factors for missed IVR calls overlap with those for missed appointments. Involvement of informal caregivers may significantly increase engagement.
authors.affiliation: Department of Veterans Affairs, Center for Clinical Management Research, University of Michigan Medical School, Ann Arbor, MI 48109-2800, USA. jpiette@umich.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Rosland
authors.forename: Nicolle S
authors.initials: NS
authors.lastname: Marinec
authors.forename: Dana
authors.initials: D
authors.lastname: Striplin
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Silveira
mesh_terms: D000368:Aged; D001331:Automation; D017028:Caregivers; D002908:Chronic Disease / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy; D019468:Disease Management; D005246:Feedback; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy; D017010:Reminder Systems; D012648:Self Care; D012944:Social Support; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D014481:United States