50 / 244
affirmation, euphoria, fulfillment, lively feeling, and inde-
pendence. Patients positively having well-being could conduct
their own activities towards achieving self-management of
diabetes. This indicates that their successful experience of
self-management is one of the important factors to support
healthy feelings.
The results revealed that the score distribution of the diabetic
group was different from those of the control group and
the neurologic group. There were no significant differences in
the mean scores of stress between the diabetic group and
the control group. These results strongly suggested that the
improvement of well-being among the patients would support
the self-management of diabetes.
Due to the increased average life expectancy to the age of 90,
identity has become increasingly critical in the 40s and 50s, the
transition stages of life, as well as in the puberty. Poor physical
functioning, climacteric disturbance, psychological decline,
socio-occupational instability in life stages may force persons
to change their lifestyles.
As suggested by Jungian psychology, we believe that con-
sidering lifestyles after the age of 40 may provide the new
possible way of living. The results of the present study have
shown possible benefits to patients with diabetes in addres-
sing the future challenges to verify the hypothesis on mental
states of the patients through longitudinal and cross-sectional
studies.
Taiwanese Diabetes Care 3.0
–
Improving
Efficiency through Automation
SP02-2
Improving self-management and diabetes education
programs through analytics and automation
Shih-Tzer TSAI
1
.
1
Taipei Veterans General Hospital, Taipei, Taiwan
For decades, diabetes self-management and shared care
programs have been recognized as an integral part in
improving patient outcomes. The success of self-care is often
credited to structured education and empowerment of the
patients.
While studies around the world have repeatedly shown
positive outcomes with structured care programs, low
coverage rates of patients have not been resolved. In
many parts of the world, including Taiwan, UK and the
United States, the coverage rates are only at 15% to 25%.
Known barriers from the perspective of both patients and
providers have caused low coverage rates. Low patient
involvement may be categorized into those who
“
don
’
t
know
”
,
“
can
’
t go
”
and
“
won
’
t go
”
(Vivien Coates, 2015); while
providers face issues mainly related to limited resources and
time in midst of ever rising patient census. Considering
different countries have different systems (finance, resources),
it is often difficult to replicate the effective care programs
across the borders.
Over the past 18 months, an online diabetes management
solution (including a mobile app for patients and a web-based
patient management platform for care providers) was
deployed to over 2,000 diabetes patients in Taiwan. The
clients connected to one of the varying degrees of educator
engagement or service: (1) none at all, (2) passive, and (3)
proactive. We examine the effectiveness of this solution
in terms of varying degrees of educator involvement.
Furthermore, we will also discuss how the online system
leverages analytics and automation for self-management; (1)
how the platform brings new delight to patient engagement,
support, and (2) how it supplements for the lack of diabetes
educator resources and in some extent compensate each of the
five levels of diabetes educators.
*
At the end, we will also
discuss how the online solution collects and analyzes data;
enables care providers to interpret results, deliver tailored
messages, and take action to change practice.
*American Association of Diabetes Educators (AADE) (2011).
Scope of Practice, Standards of Practice, and Standards of
Professional Performance for Diabetes Educators
Level 1
–
Non-healthcare professional
Level 2
–
Healthcare professional non-diabetes educator
Level 3
–
Non-credentialed diabetes educator
Level 4
–
Credentialed diabetes educator
Level 5
–
Advanced level diabetes educator/clinical manager
SP02-3
Assessment of the cost-effectiveness and clinical outcomes of
a fourth generation synchronous telehealth program for the
management of chronic cardiovascular disease: A
longitudinal study
Yi-Lwun HO
1
.
1
Department of Medicine, National Taiwan
University School of Medicine, Taipei, Taiwan
Background:
Telehealth program is a growing field for the care
of patients. The evolution of information technology has
resulted in telehealth becoming a fourth generation synchron-
ous program. The long-term outcome and the cost-effective-
ness analysis of such program have not been reported in
patients with chronic cardiovascular diseases.
Objectives:
We conducted this study to assess the clinical
outcomes and cost-effectiveness of a fourth generation, syn-
chronous telehealth program for patients with chronic cardio-
vascular diseases.
Methods:
We retrospectively analyzed 576 patients who
had joined a telehealth program and compared them with
1,178 patients matched for sex, age and Charlson comorbidity
index. The program included: (1) instant transmission of
biometric data; (2) daily telephone interview; and (3) con-
tinuous decision-making support. Data on hospitalization,
emergency department (ED) visits and medical costs were
collected from the hospital
’
s database, and were adjusted to
the follow-up months. A Cox proportional hazards model was
fitted to analyze the impact of risk predictors on all-cause
mortality. The model adjusted for age, sex, and chronic
comorbidities.
Results:
Themean agewas 64.5 years. The numbers ofmonthly
ED visits (0.06 vs. 0.09, p < .001), hospitalizations (0.05 vs. 0.11,
p < .001), length of hospitalization (days, 0.77 vs. 1.4, p < .001)
and intensive care unit admissions (0.01 vs 0.036, p < .001) were
lower in the telehealth group. The monthly costs of ED visits
(US$20.9 vs US$37.3, p < .001), hospitalizations (US$386.3 vs US
$878.2, p < .001) and all medical costs (US$587.6 vs US$1,163.6,
p < .001) were lower in the telehealth group. The intervention
costs were US$224.8 per month. There were 53 (9.27%) deaths
in the telehealth group and 136 (11.5%) deaths in the control
group. A Cox
’
s regression model with time-varying covariates
results showed an estimated HR of 0.866 (95% CI 0.837
–
0.896,
p < 0.001; number needed to treat at one year = 55.6, 95% CI
43.2
–
75.7, based on HR of telehealth program) for telehealth
program on all-causemortality after adjusting for age, sex, and
comorbidities.
Conclusions:
Better cost-effectiveness and clinical outcomes
were noted with the use of a fourth generation synchronous
telehealth program in patients with chronic cardiovascular
diseases. Such telehealth program is also associated with less
all-cause mortality compared with usual care, after adjusting
for chronic comorbidities.
Speech Abstracts / Diabetes Research and Clinical Practice 120S1 (2016) S1
–
S39
S32