The purpose of this project is to develop a novel direct-to-patient alert using text messaging. The text messages will be targeted to patients found to be at a high risk for elevated blood sugar using a previously validated risk calculator that was created from routine data available in an electronic health record (EHR), which was found to be significantly more accurate than existing tools for identifying at risk patients. Text messages will be sent to high-risk individuals who have agreed to receive texts. The message will inform patients of their elevated risk for diabetes, invite patients to undergo a free diabetes screening test, and provide a link to a web page containing additional relevant information. Studies that improve the detection of patients with abnormal glucose are important because most patients diagnosed with Type 2 Diabetes already have evidence of end-organ damage by the time the disease is identified. Earlier diagnosis can lead to additional prevention strategies to detect and reduce associated morbidities by alerting the physician and patient to a previously unrecognized health status and facilitate shared decision making. The patients will be offered the opportunity to undergo a free diabetes-screening test (glycated hemoglobin) that does not require fasting, can be performed at the patients' convenience, and does not require an office visit. Patients with an elevated glycated hemoglobin (>5.7%) will be encouraged to follow-up with their physician. An additional component of the grant is a qualitative study that will perform focus groups with patients to create the most appealing texting intervention possible. Preliminary findings indicate a strong preference for texting over alternative modes of communication and identify favorable content components and phrasing. The inclusion of an informational web page was suggested by preliminary focus groups to enhance content and length of the message. The qualitative component is important as it explores ways to optimize direct patient engagement as a means to overcome the poor response of physicians to electronic reminders due to a phenomenon that has been termed, ?alert fatigue.? The project is also novel in the use of text messaging, which has recently become both inexpensive and widely available across all ages, races and income groups for a direct-to patient intervention. Previous research indicates that universal screening for diabetes is not cost-effective, while targeted screening using crude patient groups is marginally cost-effective. Although this pilot grant will likely be too small to demonstrate definitive cost benefits of targeted diabetes screening using a risk calculator, it will set the stage for a larger randomized trial in the future. This pilot and a future trial can also contribute to the wider assessment of the viability of texting as a tool for preventative medicine in general and serve as evidence to support greater routine use of interventions involving accessible and cost-effective health information technology methods that are currently underutilized by demonstrating successful flow from application of the calculator to EHR data to text to laboratory results. The authors strongly believe in patient empowerment and hope that this project will encourage more studies to leverage direct patient interventions based on personalized recommendations to promote self-efficacy and equity within the health care system.

R21HS026803

2019-04-01

2021-03-31