title: Delivery of integrated diabetes care using logistics and information technology--the Joint Asia Diabetes Evaluation (JADE) program.
abstract: Diabetes is a global epidemic, and many affected individuals are undiagnosed, untreated, or uncontrolled. The silent and multi-system nature of diabetes and its complications, with complex care protocols, are often associated with omission of periodic assessments, clinical inertia, poor treatment compliance, and care fragmentation. These barriers at the system, patient, and care-provider levels have resulted in poor control of risk factors and under-usage of potentially life-saving medications such as statins and renin-angiotensin system inhibitors. However, in the clinical trial setting, use of nurses and protocol with frequent contact and regular monitoring have resulted in marked differences in event rates compared to epidemiological data collected in the real-world setting. The phenotypic heterogeneity and cognitive-psychological-behavioral needs of people with diabetes call for regular risk stratification to personalize care. Quality improvement initiatives targeted at patient education, task delegation, case management, and self-care promotion had the largest effect size in improving cardio-metabolic risk factors. The Joint Asia Diabetes Evaluation (JADE) program is an innovative care prototype that advocates a change in clinic setting and workflow, coordinated by a doctor-nurse team and augmented by a web-based portal, which incorporates care protocols and a validated risk engine to provide decision support and regular feedback. By using logistics and information technology, supported by a network of health-care professionals to provide integrated, holistic, and evidence-based care, the JADE Program aims to establish a high-quality regional diabetes database to reflect the status of diabetes care in real-world practice, confirm efficacy data, and identify unmet needs. Through collaborative efforts, we shall evaluate the feasibility, acceptability, and cost-effectiveness of this "high tech, soft touch" model to make diabetes and chronic disease care more accessible, affordable, and sustainable.
authors.affiliation: Department of Medicine and Therapeutics, China; Hong Kong Institute of Diabetes and Obesity, China; Li Ka Shing Institute of Health Sciences, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China; Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China. Electronic address: jchan@cuhk.edu.hk.
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
authors.affiliation: Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Risa
authors.initials: R
authors.lastname: Ozaki
authors.affiliation: Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Andrea
authors.initials: A
authors.lastname: Luk
authors.affiliation: Department of Medicine and Therapeutics, China; Hong Kong Institute of Diabetes and Obesity, China; Li Ka Shing Institute of Health Sciences, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Alice P S
authors.initials: AP
authors.lastname: Kong
authors.affiliation: Department of Medicine and Therapeutics, China; Hong Kong Institute of Diabetes and Obesity, China; Li Ka Shing Institute of Health Sciences, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Ronald C W
authors.initials: RC
authors.lastname: Ma
authors.affiliation: Department of Medicine and Therapeutics, China; Hong Kong Institute of Diabetes and Obesity, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China; Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China.
authors.forename: Francis C C
authors.initials: FC
authors.lastname: Chow
authors.affiliation: Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China.
authors.forename: Patrick
authors.initials: P
authors.lastname: Wong
authors.affiliation: Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wong
authors.affiliation: Hong Kong Institute of Diabetes and Obesity, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Harriet
authors.initials: H
authors.lastname: Chung
authors.affiliation: Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Cherry
authors.initials: C
authors.lastname: Chiu
authors.affiliation: Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China.
authors.forename: Troels
authors.initials: T
authors.lastname: Wolthers
authors.affiliation: Department of Medicine and Therapeutics, China; Qualigenics Diabetes Centre, Central, Hong Kong SAR, China.
authors.forename: Peter C Y
authors.initials: PC
authors.lastname: Tong
authors.affiliation: Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Gary T C
authors.initials: GT
authors.lastname: Ko
authors.affiliation: Department of Medicine and Therapeutics, China; International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Prince of Wales Hospital, China.
authors.forename: Wing-Yee
authors.initials: WY
authors.lastname: So
authors.affiliation: Asia Diabetes Foundation, Prince of Wales Hospital, Shatin, China.
authors.forename: Greg
authors.initials: G
authors.lastname: Lyubomirsky
mesh_terms: D001208:Asia; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D008490:Medical Informatics / Q000379:methods*; D009934:Organization and Administration; D015397:Program Evaluation
keywords: Information technology; Integrated diabetes care; JADE; Logistics; Quality improvement