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Research Paper |
Affiliations of the authors: Departments of Medicine (SSh, WP, LF, RG, RAL), Biomedical Informatics (SSh, JS, MA, CH), and Radiology (JS) and Naomi Berrie Diabetes Center (RG), Columbia University, New York, NY; Departments of Epidemiology (SSh) and Biostatistics (EP), Joseph Mailman School of Public Health, Columbia University, New York, NY; Joslin Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY (RSW, REI, SM); Department of Veterans Affairs, VA Medical Center, Syracuse, NY (RSW); Research Division of the Hebrew Home for the Aged at Riverdale, Bronx, NY (JT, SSi, DH); Stroud Center, Columbia University, and New York State Psychiatric Institute, New York, NY (JT); Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY (LTW); Department of Medicine, Harlem Hospital Center, New York, NY (LC).
Correspondence and reprints: Steven Shea, MD, Division of General Medicine, 630 W. 168th Street, New York, NY 10032; e-mail: <ss35{at}columbia.edu>
Received for publication: 07/22/05; accepted for publication: 09/21/05.
Background: Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness.
Methods: The authors conducted a randomized, controlled trial comparing telemedicine case management to usual care, with blinding of those obtaining outcome data, in 1,665 Medicare recipients with diabetes, aged 55 years or greater, and living in federally designated medically underserved areas of New York State. The primary endpoints were HgbA1c, blood pressure, and low-density lipoprotein (LDL) cholesterol levels.
Results: In the intervention group (n = 844), mean HgbA1c improved over one year from 7.35% to 6.97% and from 8.35% to 7.42% in the subgroup with baseline HgbA1c 
7% (n = 353). In the usual care group (n = 821) mean HgbA1c improved over one year from 7.42% to 7.17%. Adjusted net reductions (one-year minus baseline mean values in each group, compared between groups) favoring the intervention were as follows: HgbA1c, 0.18% (p = 0.006), systolic and diastolic blood pressure, 3.4 (p = 0.001) and 1.9 mm Hg (p < 0.001), and LDL cholesterol, 9.5 mg/dL (p < 0.001). In the subgroup with baseline HgbA1c 7%, net adjusted reduction in HgbA1c favoring the intervention group was 0.32% (p = 0.002). Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dL. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York.
Conclusion: Telemedicine case management improved glycemic control, blood pressure levels, and total and LDL cholesterol levels at one year of follow-up.
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