Expanding Technology-Enabled, Nurse-Delivered Chronic Disease Care : A Pragmatic, Randomized,...

Area of Science:

• Health Services Research
• Digital Health
• Chronic Disease Management

Background:

• Comprehensive telehealth is effective in integrated systems but rarely used in fee-for-service (FFS) models.
• Implementation in FFS settings for chronic diseases remains underexplored.

Purpose of the Study:

• To assess the effectiveness and implementation of comprehensive telehealth for uncontrolled type 2 diabetes (T2D) and hypertension within an FFS environment.
• To identify barriers and facilitators to telehealth delivery in primary care and endocrinology clinics.

Main Methods:

• A pragmatic, randomized effectiveness-implementation trial was conducted across 6 academic clinics.
• Participants with T2D (HbA1c ≥8.0%) and hypertension received either a control (self-monitoring) or comprehensive telehealth intervention for 12 months.

Main Results:

• Comprehensive telehealth showed a non-significant trend toward greater HbA1c reduction (-1.1% vs -0.7% for control).
• No significant differences were observed in secondary outcomes, except for diabetes self-care, which favored the telehealth group.
• Intervention fidelity was suboptimal, with identified barriers to program delivery.

Conclusions:

• Comprehensive telehealth did not substantially lower HbA1c compared to usual care in this FFS setting.
• Factors such as population characteristics, program design, and FFS implementation barriers likely influenced outcomes.
• Further research is needed to optimize telehealth delivery in FFS models for chronic disease management.