title: A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial.
abstract: Advances in technology are likely to provide new approaches to address healthcare disparities for high-risk populations. This study explores the feasibility of a new approach to health disparities research using a multidisciplinary intervention and advanced communication technology to improve patient access to care and chronic disease management. A high-risk cohort of uninsured, poorly-controlled diabetic patients was identified then randomized pre-consent with stratification by geographic region to receive either the intervention or usual care. Prior to enrollment, participants were screened for readiness to make a behavioral change. The primary outcome was the feasibility of protocol implementation, and secondary outcomes included the use of patient-centered medical home (PCMH) services and markers of chronic disease control. The intervention included a standardized needs assessment, individualized care plan, intensive management by a multidisciplinary team, including health coach-facilitated virtual visits, and the use of a cloud-based glucose monitoring system. One-hundred twenty-seven high-risk, potentially eligible participants were randomized. Sixty-one met eligibility criteria after an in-depth review. Due to limited resources and time for the pilot, we only attempted to contact 36 participants. Of these, we successfully reached 20 (32%) by phone and conducted a readiness to change screen. Ten participants screened in as ready to change and were enrolled, while the remaining 10 were not ready to change. Eight enrolled participants completed the final three-month follow-up. Intervention feasibility was demonstrated through successful implementation of 13 out of 14 health coach-facilitated virtual visits, and 100% of participants indicated that they would recommend the intervention to a friend. Protocol feasibility was demonstrated as eight of 10 participants completed the entire study protocol. At the end of the three-month intervention, participants had a median of nine total documented contacts with PCMH providers compared to four in the control group. Three intervention and two control participants had controlled diabetes (hemoglobin A1C <9%). Multidisciplinary care that utilizes health coach-facilitated virtual visits is an intervention that could increase access to intensive primary care services in a vulnerable population. The methods tested are feasible and should be tested in a pragmatic randomized controlled trial to evaluate the impact on patient-relevant outcomes across multiple chronic diseases.
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Ave. Charlotte, NC 28205, USA. jemerson@ghs.org.
authors.forename: John F
authors.initials: JF
authors.lastname: Emerson
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Ave. Charlotte, NC 28205, USA. Madelyn.Welch@carolinas.org.
authors.forename: Madelyn
authors.initials: M
authors.lastname: Welch
authors.affiliation: Dickson Advanced Analytics, 720 E. Morehead Street, Charlotte, NC 28202, USA. Whitney.Rossman@carolinashealthcare.org.
authors.forename: Whitney E
authors.initials: WE
authors.lastname: Rossman
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Ave. Charlotte, NC 28205, USA. Stephen.Carek@carolinas.org.
authors.forename: Stephen
authors.initials: S
authors.lastname: Carek
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Ave. Charlotte, NC 28205, USA. Tom.Ludden@carolinas.org.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ludden
authors.affiliation: Dickson Advanced Analytics, 720 E. Morehead Street, Charlotte, NC 28202, USA. Megan.Templin@carolinas.org.
authors.forename: Megan
authors.initials: M
authors.lastname: Templin
authors.affiliation: Dickson Advanced Analytics, 720 E. Morehead Street, Charlotte, NC 28202, USA. Charity.Patterson@carolinashealthcare.org.
authors.forename: Charity G
authors.initials: CG
authors.lastname: Moore
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Ave. Charlotte, NC 28205, USA. Hazel.Tapp@carolinas.org.
authors.forename: Hazel
authors.initials: H
authors.lastname: Tapp
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Ave. Charlotte, NC 28205, USA. Michael.Dulin@carolinas.org.|Dickson Advanced Analytics, 720 E. Morehead Street, Charlotte, NC 28202, USA. Michael.Dulin@carolinas.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Dulin
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Ave. Charlotte, NC 28205, USA. Andrew.McWilliams@carolinas.org.|Dickson Advanced Analytics, 720 E. Morehead Street, Charlotte, NC 28202, USA. Andrew.McWilliams@carolinas.org.
authors.forename: Andrew
authors.initials: A
authors.lastname: McWilliams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009657:North Carolina; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000379:methods* / Q000458:organization & administration; D010865:Pilot Projects; D011446:Prospective Studies; D017216:Telemedicine / Q000379:methods* / Q000458:organization & administration; D016896:Treatment Outcome; D055815:Young Adult
keywords: health coach; population health; readiness to change; refractory to primary care; risk stratification; virtual care