Benefits of Information Technology-Enabled Diabetes Management

From Clinfowiki
Jump to: navigation, search

Bu D., Pan E., et al. Benefits of Information Technology-Enabled Diabetes Management. Diabetes Care. 2007 Feb 23; DOI: 10.2337/dc06-2101.

Diabetes is a chronic disease that requires life-long management. If untreated, diabetes can cause serious complications such as cardiovascular disease, blindness, and amputations. Successful diabetes management is highly dependent on patient compliance with treatment and on regular monitoring of patients. The cost of diabetes care in the U.S. is very high ($132 billion in 2002), but it could be reduced if treatment compliance were improved.

Some groups in the medical community, such as the National Institutes of Health, believe that information technology can be used to improve diabetes management. However, there is limited evidence to support this belief. Therefore the authors conducted research to quantify the benefits of Information Technology-enabled diabetes management (ITDM) on medical costs and clinical outcomes for Type 2 diabetes in patients 25 years old or older. The authors categorize diabetes management technologies into three groups:

1. Provider-Centered Technologies

Examples of provider-centered technologies are diabetes registries and clinical decision support systems.

2. Patient-Centered Technologies

These are technologies that help patients manage their own care. Some examples are remote monitoring systems, automated phone reminders, electronic diaries, and online educational materials.

3. Payer Technologies

An example is analysis of health care claims data to evaluate treatment programs.

The authors calculated the benefits of each type of technology from the results of published studies of diabetes management programs. They also calculated the costs per year of Type 2 diabetes in patients 25 years or older in the United States using data from the Centers for Disease Control and the American Diabetes Association. They then created a computer simulation that projected the effect on costs and outcomes if the information technologies were implemented in diabetes management programs throughout the United States for a period of ten years.

The researchers conclude that all forms of ITDM would produce cost savings and improved health outcomes. They estimate that ITDM would generate medical cost savings of approximately $32 billion over ten years (in 2004 dollars) due to a decrease in diabetes complications. They also ranked the types of technology in order of savings and outcome improvements. They found that provider-centered technologies (especially diabetes registries) produced the greatest cost savings and the greatest reductions in diabetes complications. Payer technologies came in second in both cost savings and reductions in complications, while patient-centered technologies had the smallest cost savings. Patient-centered technologies had no statistically significant effect on diabetes complications except for cardiovascular complications. In addition, the authors hypothesize that integrated systems containing both provider-centered and patient-centered technologies would produce the largest cost savings. However, there are no commercially available integrated provider-patient diabetes care systems available at the current time.

The authors acknowledge that using a computer simulation to project benefits has limitations. Their estimates of cost savings and outcome improvements are dependent on the selection and quality of the studies in their literature review. Also, it may not be valid to project the results from a study in a specific health care setting to the entire United States health system. But the authors believe that randomized controlled trials of ITDM are unlikely to be conducted. Therefore they believe their approach is a good way to evaluate the effectiveness of different technologies. With limited IT budgets, this type of evaluation can help guide decisions on which technologies to invest in. However, the authors did not perform a true cost-benefit analysis since they did not include implementation costs in their study because implementation costs are variable and are often not published. Of course, health care organizations must consider implementation costs as well as possible benefits.

This article could be useful to anyone responsible for diabetes care, such as physicians, health insurers, health care administrators and managers, public health agencies, and government health agencies. It could also be useful to persons interested in applying information technology to health care such as biomedical informaticists and clinical information system developers.

Maria Reiss