Association Between Frequency of Telephonic Contact and Clinical Testing for a Large, Geographically Diverse Diabetes Disease Management Population

Published in Population Health Management

Author(s): Carter R. Coberley, PhD; Matthew Mcginnis, BS; Patty M. Orr, MSN, EdD, RN; Sadie S. Coberley, PhD; Adam Hobgood, MS; Brent Hamar, DDS, MPH; Bill Gandy, EdD, James Pope, MD; Laurel Hudson, RN, MSN; Pam Hara, RN, MBA; Dexter Shurney, MD, MBA, MPH; Janice L. Clarke, RN; Albert Crawford, PhD, MBA, MSIS; and Neil I. Goldfarb, BA

Diabetes disease management (DM) programs strive to promote healthy behaviors, including obtaining hemoglobin A1c (A1c) and low-density lipoprotein (LDL) tests as part of standards of care.

The purpose of this study was to examine the relationship between frequency of telephonic contact and A1c and LDL testing rates. A total of 245,668 members continuously enrolled in diabetes DM programs were evaluated for performance of an A1c or LDL test during their first 12 months in the programs. The association between the number of calls a member received and clinical testing rates was examined. Members who received four calls demonstrated a 24.1% and 21.5% relative increase in A1c and LDL testing rates, respectively, compared to members who received DM mailings alone. Response to the telephonic intervention as part of the diabetes DM programs was influenced by member characteristics including gender, age, and disease burden. For example, females who received four calls achieved a 27.7% and 23.6% increase in A1c and LDL testing, respectively, compared to females who received mailings alone; by comparison, males who were called achieved 21.2% and 19.9% relative increase in A1c and LDL testing, respectively, compared to those who received mailings alone.

This study demonstrates a positive association between frequency of telephonic contact and increased performance of an A1c or LDL test in a large, diverse diabetes population participating in DM programs. The impact of member characteristics on the responsiveness to these programs provides DM program designers with knowledge for developing strategies to promote healthy behaviors and improve diabetes outcomes.

Key Takeaways:

• Hemoglobin A1c is an indicator of glycemic control in diabetes. A1c levels are associated with complications such as retinopathy, kidney failure and peripheral neuropathy.
• High LDL cholesterol is risk factor for cardiovascular disease, as is diabetes.
• Participation in telephonic disease management for patients with diabetes was associated
  with increased adherence to A1c and LDL testing, important standards of care.
• Clinical testing rates increased with an increasing number of successful calls to participants.
• Telephonic disease management can improve adherence to clinical testing, which should
  lead to improved clinical outcomes.