title: Social impact analysis of the effects of a telemedicine intervention to improve diabetes outcomes in an ethnically diverse, medically underserved population: findings from the IDEATel Study.
abstract: OBJECTIVE
  We examined the social impact of the telemedicine intervention effects in lower- and higher-socioeconomic status (SES) participants in the Informatics for Diabetes Education and Telemedicine (IDEATel) study.
  
  
  METHODS
  We conducted a randomized controlled trial comparing telemedicine case management with usual care, with blinded outcome evaluation, in 1665 Medicare recipients with diabetes, aged 55 years or older, residing in federally designated medically underserved areas of New York State. The primary trial endpoints were hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, and systolic blood pressure levels.
  
  
  RESULTS
  HbA1c was higher in lower-income participants at the baseline examination. However, we found no evidence that the intervention increased disparities. A significant moderator effect was seen for HbA1c (P = .004) and systolic blood pressure (P = .023), with the lowest-income group showing greater intervention effects.
  
  
  CONCLUSIONS
  Lower-SES participants in the IDEATel study benefited at least as much as higher-SES participants from telemedicine nurse case management for diabetes. Tailoring the intensity of the intervention based on clinical need may have led to greater improvements among those not at goal for diabetes control, a group that also had lower income, thereby avoiding the potential for an innovative intervention to widen socioeconomic disparities.
authors.affiliation: Steven Shea, Rafael A. Lantigua, and Walter Palmas are with the Department of Medicine, Columbia University, New York, NY. At the time of this study, Dhruva Kothari was with the College of Physicians & Surgeons, Columbia University. Jeanne A. Teresi, Jian Kong, and Joseph P. Eimicke are with the Research Division of the Hebrew Home at Riverdale, Bronx, NY. Jeanne A. Teresi is also with the Morris W. Stroud, III, Center for Studies on Quality of Life, Columbia University. Ruth S. Weinstock is with Joslin Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Dhruva
authors.initials: D
authors.lastname: Kothari
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Teresi
authors.forename: Jian
authors.initials: J
authors.lastname: Kong
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Lantigua
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000208:ethnology / Q000628:therapy*; D023381:Endpoint Determination; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009518:New York; D058996:Quality Improvement; D012923:Social Class; D017216:Telemedicine; D016896:Treatment Outcome