ATDM: Automated Telephone Disease Management

No. It’s not my term or even a company term. I am not sure who came up with it, but it was actually used in a published study from 2001.

“Impact of Automated Calls With Nurse Follow-Up on Diabetes Treatment Outcomes in a Department of Veterans Affairs Health Care System.”
Diabetes Care 24:202-208
2001
John D. Piette, PHD, Morris Weinberger, PHD, Frederic B. Kraemer, MD, and Stephen J. McPhee, MD
Contact John Piette (jpiette@stanford.edu) for more information (Center for Health Care Evaluation)

“Findings from multiple studies indicate that chronically ill patients will participate in ATDM and that the information they report during ATDM assessments is at least as reliable as information obtained via structured clinical interviews or medical record reviews. Indeed, some patients are more inclined to report health problems during an automated assessment than directly to a clinician.”

Obviously, given Silverlink’s historical focus, these kind of external validations are important. I cited the one on exercise from Stanford a few months ago.

Here were a few highlights from the article:

• Obj: evaluate ATDM with telephone nurse follow-up to improve diabetes treatment and outcomes in Department of Veterans Affairs
• Design: 272 diabetes patients using hypoglycemic medications in randomized 1-year study. Bi-weekly ATDM health assessment and self-care education calls. Nurse educator followed up based on assessment reports. Automated survey measured self-care, symptoms, and satisfaction. Outpatient service use was captured. Glycemic control was measured.
• Results: intervention patients reported more frequent glucose self-monitoring and foot inspections. Intervention patients were more likely to be seen in specialty clinics and have had a cholesterol test. Intervention patients reported fewer symptoms of poor glycemic control and greater satisfaction with their healthcare.
• Conclusion: intervention improved the quality of VA diabetes care.
• Description of the intervention:
  • Structured messages using statements and queries
  • Recorded human voice
  • Outbound
  • 5-8 minute calls
  • Used touch-tone keypad to report information (now you would use speech recognition to collect the data)
  • Offered an optional health promotion message at the end of the call
  • Each week the nurse reviewed the data and followed up with patients based on established protocol
• Intervention process:
  • Average patient received 15 ATDM calls over the 12 months
  • 50% were very satisfied (31% moderately satisfied)
  • 97% said the messages were mostly or always easy to understand
  • 76% said the calls made them feel like their MD knew how they were doing
  • 67% said the calls reminded them to engage in self-care activities
  • 79% said they would be more satisfied with their healthcare if they got such calls
  • 73% said they would personally choose to receive such calls

Obviously, if you’re very interested in the topic, you should read the article to get all the finer points.

My takeaways are that if this technology worked in 2000 then it should be even more effective now. There have been lots of improvements. Additionally, we all know the costs of diabetes (and many other diseases) and the cost of using nurses as the primary means of follow-up.