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Diabetes Health Information Technology Innovation to Improve Quality of Life for Health Plan Members in Urban Safety Net

Ratanawongsa, Neda MD, MPH; Handley, Margaret A. PhD, MPH; Sarkar, Urmimala MD, MPH; Quan, Judy PhD; Pfeifer, Kelly MD; Soria, Catalina BA; Schillinger, Dean MD

Journal of Ambulatory Care Management: April/June 2014 - Volume 37 - Issue 2 - p 127–137
doi: 10.1097/JAC.0000000000000019
Original Articles

Safety net systems need innovative diabetes self-management programs for linguistically diverse patients. A low-income government-sponsored managed care plan implemented a 27-week automated telephone self-management support/health coaching intervention for English-, Spanish-, and Cantonese-speaking members from 4 publicly funded clinics in a practice-based research network. Compared to waitlist, immediate intervention participants had greater 6-month improvements in overall diabetes self-care behaviors (standardized effect size [ES] = 0.29, P < .01) and 12-Item Short Form Health Survey physical scores (ES = 0.25, P = .03); changes in patient-centered processes of care and cardiometabolic outcomes did not differ. Automated telephone self-management is a strategy for improving patient-reported self-management and may also improve some outcomes.

General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco (Drs Ratanawongsa, Handley, Sarkar, Quan, and Schillinger, and Ms Soria); Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco (Dr Handley); San Francisco Health Plan, San Francisco, California (Dr Pfeifer); and California Diabetes Program, California Department of Public Health, Sacramento (Dr Schillinger).

Correspondence: Neda Ratanawongsa, MD, MPH, Division of General Internal Medicine, UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, 1001 Potrero Ave, Box 1364, San Francisco, CA 94110 (

The San Francisco Health Plan participated in the design and implementation of the intervention and evaluation. The study was funded by the Agency for Healthcare Research and Quality grants R18HS017261 and 1R03HS020684-01; Centers for Disease Control and Prevention grant 5U58DP002007-03; Health Delivery Systems Center for Diabetes Translational Research (CDTR) funded through NIDDK grant 1P30-DK092924; National Institute on Minority Health and Health Disparities P60MD006902; and the McKesson Foundation. NIH grant UL1 RR024131 supports the University of California San Francisco Collaborative Research Network. No funders had any role in the study design; collection, analysis, and interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication.

None of the authors had conflicts of interest, and the funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. All authors contributed to the conception and design, and drafting and critical revision of the manuscript, including final approval of the version to be published.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins