Epharmix clinical team members Katie Foster and Eric Sink attended the ACP Internal Medicine Meeting 2016 in Washington, DC. Read the abstracts for both entries below:
EpxDiabetes accelerates blood glucose control for patients with diabetes
- Foster K
- Javaherian K
- Zhang CR
- Patel K
- Schell A
- Huynh J
- Blanchard M
Blood glucose control for diabetics remains a difficult goal to achieve among patients, in particular because of inconsistent communication of blood glucose values to physicians outside of office visits. Blood glucose diaries have low compliance rates, and underlying socioeconomic issues, medication side effects, and medication non-compliance contribute to blood glucose control difficulties. To address these issues, we designed, implemented, and piloted an inexpensive automated text message (SMS) and phone communication system, EpxDiabetes, to aid in the management of Diabetes.
EpxDiabetes was designed based on interviews with academic and community physicians and patients at Washington University in St. Louis, Mercy Hospital, and the Family Care Health Center. EpxDiabetes sends regular prompts to patients to report their fasting blood glucose (FBG) via SMS or phone call. The system algorithmically adapts to the patient’s needs and can vary message frequency appropriately. If the patient reports a FBG value beyond set thresholds, their provider receives an actionable alert. For longitudinal monitoring, EpxDiabetes provides a regular report prioritized by average FBG levels. In this pilot, a total of 35 patients were followed for over 8 weeks at Mercy Hospital and Washington University in St. Louis while tracking response rates and average FBG levels.
Preliminary results show that, on average, 86% of patients respond to the system each week. We have found that patients using EpxDiabetes for 8 weeks have experienced a 34.6 point reduction in FBG from a baseline calculated as the average of the first week of reported FBG values. In these patients, median baseline was 168.1 with an interquartile range of 158.8 to 196.5. In addition, we have been able to identify and alert providers in realtime to 11 cases of acute hypoglycemic or hyperglycemic events over the 8-week period for the 35 patients initially recruited. We also report a cost-benefit analysis that demonstrates the capability of EpxDiabetes to be sustainable and generate revenue for practices via novel fee-for-service codes.
EpxDiabetes is a novel system that leverages an inexpensive, widely adopted technology to provide clinically relevant information to the provider and efficiently improve patient-provider communication. In an initial pilot, EpxDiabetes demonstrated strong patient engagement and retention as well as beneficial effects on FBG levels in diabetes patients. A 400-subject randomized controlled trial to assess the impact of this system on HbA1c reduction and patient compliance will begin in January 2016, with interim findings available by May 2016.
An Automated Telemonitoring System for COPD Management
- First Author: Jacob Groenendyk
- Second Author: Eric Sink
- Third Author: Kavon Javaherian
- Fourth Author: Kelly Dodds
- Fifth Author: Leslie Cummings-Vaughn
- Sixth Author: Melvin Blanchard
Chronic Obstructive Pulmonary Disorder (COPD) is an irreversible respiratory disease characterized by narrowing and inflammation of the airways. It affects over 15 million Americans and is now the third leading cause of death in the United States. Patients suffer from dyspnea, exercise intolerance, and frequent respiratory infections. 50-75% of all COPD-related medical costs are associated with COPD exacerbation episodes, and Medicare spends over $475 million annually on COPD hospital-related readmissions. Regular monitoring of COPD patients through the use of a telemedicine system may facilitate early detection and management of these exacerbations. Previous investigators have demonstrated that COPD telehealth systems can be an effective means to monitor symptoms and reduce resource utilization. This pilot study demonstrates the development and proof of-concept of a simple, automated system to intervene in patient care before dyspneic events developed into debilitating and costly exacerbations.
We developed a generic system, Epharmix, that allows researchers to craft a condition-specific automated messaging sequence that utilizes existing telephone and SMS infrastructure. Messages for the Epharmix COPD system, EpxCOPD, were designed in collaboration with physicians, nurses, and medical students. The message sequence assesses daily breathing trends in COPD patients. We tested patient adherence and satisfaction with the system in an outpatient clinic of our affiliated hospital system. When a subject reported worsening dyspnea, an electronic alert was sent to their healthcare provider. The provider then contacted the patient to counsel them on how to return to a stable breathing state.
Over the course of the seven-month pilot, the system made 3,619 automated breathing assessments. The subjects’ cumulative weekly response rate was 96% over the course of the study, and their normalized breathing scores consistently increased over time. The rate of reported dyspneic events fell by 64% over the seven months, possibly indicating patients were learning how to better manage their condition. Prompt reporting allowed the provider to remotely alter a dyspneic subject’s plan of care without sending them to the emergency room. Feedback from a patient survey revealed high satisfaction with the service. 75% of respondents reported that they felt as if they were “in greater contact with their medical provider” by answering the automated phone calls. Economic sustainability of this system was demonstrated by performing a cost-benefit analysis using Chronic Care Management billing codes.
The results of this pilot study warrant further investigation of the EpxCOPD system for short and long-term COPD management. A 600 subject randomized-controlled trial to assess the impact of this system on hospitalizations, morbidity, and patient compliance began at Washington University in December 2015.
Read more from the ACP website.