UCSF/SFGH project to improve health outcomes among diabetes patients honored

A UCSF/San Francisco General Hospital project that used a novel communication tool to improve health outcomes among diabetes patients was honored recently with a quality leadership award from the California Health Care Safety Net Institute.

The Institute, the quality improvement partner of the California Association of Public Hospitals and Health Systems, presented its Quality Leaders Award to innovative programs within California's public hospitals and health systems that aim to meet the needs of diverse communities.

At a December 3 award ceremony in Monterey, Calif., the Institute honored San Francisco General Hospital for its Improving Diabetes Efforts Across Language and Literacy (IDEALL) project, which ran from 2003 to 2006 and was based at the UCSF Center for Vulnerable Populations at the hospital.

IDEALL was designed to combine accessible, multilingual communication technology with targeted interpersonal support, according to SFGH primary care physician Dean Schillinger, MD, a UCSF professor of medicine who serves as director of the Center for Vulnerable Populations and chief of the California Diabetes Program within the California Department of Public Health.

The project enrolled 339 patients with type 2 diabetes, many of whom had limited literacy skills and limited English proficiency. Participants were randomly assigned to one of three groups-automated telephone diabetes self-management, group medical visits or standard care-and were followed for a period of one year.

Patients in the telephone group received weekly automated phone calls in their native language, asking them about their self-care behaviors, such as medication adherence and diet, as well as their psychological and emotional well-being. Patients responded using touch-tone commands, and any response that raised red flags was immediately followed by a call from a nurse care manager who spoke the patient's primary language.

The telephone system proved superior to group-oriented support and standard care in terms of patient engagement, improved diabetes-related health outcomes, and patient safety, Schillinger and his team found. The technology was also highly cost-effective.

"We are extremely proud of the work done by the innovators of this project," said Sue Carlisle, PhD, MD, associate dean of the UCSF School of Medicine at SFGH. "This is the kind of approach to patient care that can truly make a difference in the ability not only for public hospitals but for all of our health care systems to provide improved care at lower costs."

Based on the positive initial outcomes, the automated phone system is being scaled up in collaboration with the San Francisco Health Plan, the city-sponsored local health plan. This second-generation program, SMARTSteps (Self-Management Automated and Real-Time Telephonic Support), is currently being implemented among an additional 500 diabetes patients.

SMARTSteps also includes access to real-time pharmacy claims data and up-to-date clinical registry data. Those tools will enable health plan counselors to support patients in their self-management and to assist them in sticking to-or in some cases intensifying-their medication regimens, Schillinger said.