Automated Home Telephone Monitoring in Diabetes

The long-term goal is to develop a commercial computer- based telecommunications system for monitoring ambulatory patients with serious and complex chronic illnesses. The goal is to adapt the Telephone-Linked Communications (TLC) system to diabetes mellitus; this technology is a prototype for multi-system chronic illnesses that require intense patient monitoring and education with emphasis on patient self-monitoring and self-care. The work is a natural outgrowth of a previous, simpler use of the TLC technology to monitor hypertensive patients. Use of the system was associated with significant reduction in blood pressure in a randomized clinical trial and acceptance of the technology by both patients and physicians. The work also builds upon very recent work in developing and implementing a simple application for diabetes patients in an HMO setting. In this Phase I proposal, the Diabetes Telephone Monitoring System will be developed and tested. The system will converse regularly with Type I diabetic patients in their homes. It will ask questions to determine the patient's blood glucose values, use of insulin, intercurrent episodes of hypoglycemia and other significant clinical events, knowledge of diabetic self-care standards, and performance of self-care procedures. In response to patient entries, the system will provide feedback to fill knowledge gaps and improve self-care behavior. The physicians and nurses taking care of the patient will receive regular reports designed to help them monitor clinical status and introduce changes in patient management. Patients will be sent monthly reports to show them how they are doing and to motivate them to adhere to diabetic self-care standards. To carry out conversations, the diabetes system will use computer-controlled speech generation. The patients will communicate by pressing keys on a standard touch-tone telephone. The aims of Phase I include: (1) specification of the conversation content and printed report design, (2) programming modifications of the TLC technology to support the design requirements, (3) implementation of a test version of the diabetes system, and (4) preliminary feasibility testing of the system and its commercial viability by focus groups of diabetologists and diabetes nurses.