Technologically Enhanced Coaching: A Program to Improve Diabetes Outcomes



Status:Completed
Conditions:Diabetes
Therapuetic Areas:Endocrinology
Healthy:No
Age Range:18 - 99
Updated:1/25/2018
Start Date:September 9, 2014
End Date:September 29, 2017

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Technologically Enhanced Coaching (TEC):A Program for Improving Diabetes Outcomes

Peer support programs have been demonstrated to improve glycemic control among Veterans with
poor control. This program will expand on this success by putting innovative tools in the
hands of Veteran diabetes patients. Veteran coaches who have demonstrated effective control
of their own diabetes will be trained to use communication skills to guide their peers
through a diabetes education and decision aid. This tool, which is an iPad application, draws
the patient in by showing them their personal risk and medication information derived from
baseline labs and self-reported survey data. The tool encourages interaction by providing
choices of materials to view, using audio-visual elements and incorporating a goal-setting
process for developing self-management action steps and questions to discuss with their
doctor at their next clinic visit. Ongoing weekly contact between the Veterans is supported
by a confidential phone system.

Peer mentoring and support models have been found in two recent VA Randomized Controlled
Trials (RCTs) to be more effective than usual care, financial incentives, and usual nurse
care management to improve glycemic control in high-risk Veteran patients with poor glycemic
control. Such models are important complements to provision of care by formal health care
providers as they provide sustained, flexible between-visit support. Peer supporters and
coaches can be trained in effective behavioral approaches to support other Veterans'
self-management behaviors. Such supporters, however, necessarily lack the content expertise
to help Veterans make informed treatment decisions and set health goals with their health
care providers. Accordingly, in a recent study the investigators developed and tested a
tailored, interactive computer-based tool with diabetes and medication information embedded
in the tool's software that peer coaches and other outreach workers can employ to facilitate
discussions with patients. Such tailored, interactive tools have been found to be more
effective than generic educational and decision support tools in improving clinical and
patient-centered outcomes. Moreover, these tools could enhance the sustainability and
effectiveness of coaching programs to better prepare patients to set self-management goals
and action plans, and to discuss treatment options with their health care providers. With VA
support and input from Veterans, the investigators adapted the tailored, interactive
computer-based tool for use with and by Veterans with diabetes. The investigators now propose
to incorporate this tool into a peer mentor-led diabetes self-management coaching program
among predominantly African American Veterans with poor glycemic control at the Detroit VA, a
VA health system with high rates of poor risk factor control among diabetes patients. The
investigators propose to evaluate this Technology-Enhanced Coaching (TEC) program.
Specifically, the investigators propose to:

Aim 1: Test the effectiveness of a technology-enhanced peer coaching (TEC) program in
improving glucose control relative to peer coaching without technology enhancement; and, also
test the effectiveness of peer support compared to observed usual care. For the "usual care"
observed group, the investigators will use electronic health record data to measure A1c
levels.

Aim 2: Assess the impact of the intervention on key patient-centered outcomes, including
patients' satisfaction and involvement with care, perceived social support, diabetes-specific
quality of life, and medication adherence.

Aim 3: Identify patient characteristics associated with engagement in the intervention and
mediators and moderators of the intervention's impact on patient outcomes.

In summary, the TEC program builds on the demonstrated strengths of peer support models and
of tailored, interactive decision support tools in improving diabetes self-management and
outcomes. This study will test incorporation of tailored interactive educational tools into a
peer coaching model found in prior VA RCTs to be effective in improving diabetes outcomes.

The tools tested in the proposed intervention will be disseminated for use in other VA sites
through a tool kit with training and support materials. Because the intervention addresses
barriers to disease management for chronically ill patients, physicians, and case managers,
the study may have broader impact on management practices for other chronic illnesses.

Inclusion Criteria:

- one hospitalization with a diabetes-related ICD-9 code

- two outpatient visits with a diabetes-related ICD-9 code

- at least one prescription for a glucose control medication (insulin or oral agents) or
monitoring supplies.

- [70] Potential participants must also have their most recent A1c in the prior 6 months
be at least 8.0% if age < 70 or at least 8.5% if age 70+).

Exclusion Criteria:

- Using ICD-9 diagnostic codes, the investigators will exclude patients if they have an
active substance abuse disorder or serious psychiatric illness:

- PTSD

- bipolar disorder

- dementia

- schizophrenia

- or personality disorders

- We will then send names of the patients to their primary care providers to identify
any patients who they do not recommend inviting to participate in the program.
We found this trial at
2
sites
Ann Arbor, Michigan 48113
Phone: (734) 845-3604
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Detroit, Michigan 48201
Phone: 734-222-4311
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Detroit, MI
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