Enhancing diabetes care through care coordination, telemedicine, and education: Evaluation of a rural pilot program

To provide a comprehensive evaluation of a grant-funded pilot diabetes care program. Rural adult patients living with poorly controlled diabetes were targeted for care.

Retrospective study using a purposive sample of patients at select primary care sites with a glycated hemoglobin (A1C) greater than 8%. Interventions included nurse care management, telemedicine endocrinology consults, as well as diabetes self-management education (DSME), to enhance disease management and prevention of complications.

Pre/post labs, DSME test scores, hospital claims data, satisfaction surveys, and a focus group were evaluated.

Fifty-nine adults, 21-76 years of age, participated. Interventions demonstrated statistically significant reduction in A1C (10.10 vs. 9.27; p value = 0.002); DSME test score improvement (76.23 vs. 96.04; p < 0.05) and reduced hospital utilization (Emergency Department use 0.86 vs. 0.40; p value = 0.04; inpatient admissions 0.09 vs. 0.02; p value = 0.02). Patients and providers indicated strong satisfaction with the program components. Less hospital utilization reduced emergency department costs by 51.4% and inpatient costs by 96%. A rural community advisory network indicated satisfaction in delivery of program activities and outcome measures.

This rural model shows potential for improving diabetes control, access to specialty care through telemedicine, and reduction of health care utilization costs.