Text-Based mHealth for Emergency department patients with Diabetes (TExT-MED)

在洛杉矶县的医疗保健系统中，以拉丁裔为主的低收入糖尿病患者在获得初级保健和他们需要的健康教育方面面临着重大障碍。最绝望的人来到急诊科（ED）管理他们的糖尿病，但拥挤的ED没有配备提供这种慢性护理。因此，这些患者是全国病情最严重的患者之一，死亡率几乎是其他人群的两倍，HbA1C水平处于“采取行动”范围（平均HbA1C=8.8%）。有希望的干预措施已经开发出来，但由于成本高和人员要求高，尚未广泛实施。受最近移动医疗成功的启发，设计了文本- med干预（检查急诊部糖尿病患者基于文本的移动医疗试验）。患者每天都会收到关于激励挑战、竞赛、糖尿病教育和预约/药物提醒的短信。最初的课程内容将根据国家糖尿病教育计划的材料创建，特别强调在以前的研究中发现的知识空白（例如低血糖的迹象）。在RCT评估技术成功并确保信息频率和内容的适当性之前，将进行一项小型试点研究。该试点研究的患者将参与焦点小组，使用标准定性技术对焦点小组进行分析，以完善文本- med课程。该项目最终将进行一项随机对照试验，150名控制不良的糖尿病患者（HbA1C为8%）随机接受常规治疗或文本- med治疗。在入组3个月和6个月时，将记录多项临床指标：HbA1C、糖尿病知识、自我报告健康、体重、药物依从性、身体活动、食物选择、生活质量和医疗保健利用。这种创新、适应性强、低成本的解决方案有可能改善难以接触和治疗复杂的患者群体的血糖控制、知识和健康生活方式选择。

In the Los Angeles county healthcare system, low-income, predominantly Latino patients with diabetes face significant barriers to accessing primary care and the health education they need. The most desperate come to the emergency department (ED) for management of their diabetes, but the overcrowded ED is not equipped to provide this chronic care. As a result, these patients are amongst the sickest in the nation with mortality rates nearly double that of other populations, and HbA1C levels in the "take action" range (mean HbA1C=8.8%). Promising interventions have been developed, but have not been widely implemented due to high cost and personnel requirements. . Inspired by the recent successes of mHealth, the TExT-MED intervention (Trial to Examine Text-Based mHealth for Emergency department patients with Diabetes) was designed. Patients will receive daily text messages focused on motivational challenges, contests, diabetes education, and appointment/medications reminders. The initial curriculum content will be created from National Diabetes Education Program materials with special emphasis on knowledge gaps identified in prior studies (e.g. signs of hypoglycemia). A small pilot study will be conducted prior to the RCT evaluate technical success and ensure appropriateness of message frequency and content. The patients in this pilot study will participate in focus groups which will be analyzed using standard qualitative techniques to refine the TExT-MED curriculum. The project will culminate in a randomized controlled trial of 150 patients with poorly controlled diabetes (HbA1C e8%) randomized to usual care or TExT-MED. At enrollment, 3 and 6 months, multiple clinical measures will be recorded: HbA1C, diabetes knowledge, self-reported health, weight, medication compliance, physical activity, food choices, quality of life and health care utilization. This innovative, easily adaptable and low-cost solution has potential to improve glycemic control, knowledge and healthy lifestyle choices in a patient population that has been difficult to reach and complicated to treat.