Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis


Autoři: Lee-Ling Lim aff001;  Eric S. H. Lau aff001;  Risa Ozaki aff001;  Harriet Chung aff002;  Amy W. C. Fu aff002;  Wendy Chan aff004;  Alice P. S. Kong aff001;  Ronald C. W. Ma aff001;  Wing-Yee So aff006;  Elaine Chow aff001;  Kitty K. T. Cheung aff001;  Tiffany Yau aff001;  C. C. Chow aff001;  Vanessa Lau aff002;  Rebecca Yue aff004;  Shek Ng aff007;  Benny Zee aff007;  William Goggins aff007;  Brian Oldenburg aff008;  Philip M. Clarke aff009;  Maggie Lau aff010;  Rebecca Wong aff001;  C. C. Tsang aff010;  Edward W. Gregg aff011;  Hongjiang Wu aff001;  Peter C. Y. Tong aff004;  Gary T. C. Ko aff001;  Andrea O. Y. Luk aff001;  Juliana C. N. Chan aff001
Působiště autorů: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China aff001;  Asia Diabetes Foundation, Shatin, Hong Kong SAR, China aff002;  Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia aff003;  Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China aff004;  Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China aff005;  Hospital Authority Head Office, Hong Kong SAR, China aff006;  Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China aff007;  Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia aff008;  Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom aff009;  Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong SAR, China aff010;  School of Public Health, Imperial College London, London, United Kingdom aff011
Vyšlo v časopise: Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis. PLoS Med 17(10): e1003367. doi:10.1371/journal.pmed.1003367
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003367

Souhrn

Background

Diabetes outcomes are influenced by host factors, settings, and care processes. We examined the association of data-driven integrated care assisted by information and communications technology (ICT) with clinical outcomes in type 2 diabetes in public and private healthcare settings.

Methods and findings

The web-based Joint Asia Diabetes Evaluation (JADE) platform provides a protocol to guide data collection for issuing a personalized JADE report including risk categories (1–4, low–high), 5-year probabilities of cardiovascular-renal events, and trends and targets of 4 risk factors with tailored decision support. The JADE program is a prospective cohort study implemented in a naturalistic environment where patients underwent nurse-led structured evaluation (blood/urine/eye/feet) in public and private outpatient clinics and diabetes centers in Hong Kong. We retrospectively analyzed the data of 16,624 Han Chinese patients with type 2 diabetes who were enrolled in 2007–2015. In the public setting, the non-JADE group (n = 3,587) underwent structured evaluation for risk factors and complications only, while the JADE (n = 9,601) group received a JADE report with group empowerment by nurses. In a community-based, nurse-led, university-affiliated diabetes center (UDC), the JADE-Personalized (JADE-P) group (n = 3,436) received a JADE report, personalized empowerment, and annual telephone reminder for reevaluation and engagement. The primary composite outcome was time to the first occurrence of cardiovascular-renal diseases, all-site cancer, and/or death, based on hospitalization data censored on 30 June 2017. During 94,311 person-years of follow-up in 2007–2017, 7,779 primary events occurred. Compared with the JADE group (136.22 cases per 1,000 patient-years [95% CI 132.35–140.18]), the non-JADE group had higher (145.32 [95% CI 138.68–152.20]; P = 0.020) while the JADE-P group had lower event rates (70.94 [95% CI 67.12–74.91]; P < 0.001). The adjusted hazard ratios (aHRs) for the primary composite outcome were 1.22 (95% CI 1.15–1.30) and 0.70 (95% CI 0.66–0.75), respectively, independent of risk profiles, education levels, drug usage, self-care, and comorbidities at baseline. We reported consistent results in propensity-score–matched analyses and after accounting for loss to follow-up. Potential limitations include its nonrandomized design that precludes causal inference, residual confounding, and participation bias.

Conclusions

ICT-assisted integrated care was associated with a reduction in clinical events, including death in type 2 diabetes in public and private healthcare settings.

Klíčová slova:

Cancer risk factors – Diabetes mellitus – Hospitalizations – Chronic kidney disease – Patients – Physicians – Type 2 diabetes – Type 2 diabetes risk


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