Beacon TM Paper Background August 2015

Beacon TM paper background August 2015

Background:

As part of the Beacon project, a pilot tele-monitoring intervention was introduced in 6 WNY primary care practices. The goal of the intervention was to identify patients with diabetes and co-morbid conditions who were at high-risk of hospitalization. These patients were provided with TM services, in the hopes that health problems would be identified sooner, avoiding the need for hospitalization.

Because of difficulties obtaining quantitative data to evaluate the success of the intervention, qualitative interviews were conducted with the nurses who worked at the TM agencies, and one provider and one nurse/administrative person at each practice.

Given the wide variation in quality of the practice staff interviews, we opted to focus a manuscript on the TM nurse interviews (N=8) and frame the findings as lessons learned in the process of implementing a pilot TM intervention in real-world primary care practices.

Abstract:

Background: Complications related to uncontrolled diabetes are responsible for many potentially avoidable hospitalizations. A preventive telemonitoring model, implemented for high-risk patients within primary care practices may help reduce unnecessary hospital admissions. This paper reports on telemonitoring staff experiences and lessons learned in the implementation of a pilot preventive telemonitoring (TM) model for patients with diabetes in primary care practices.

Materials and Methods: Semi-structured interviews were conducted with representatives of three TM agencies participating in the pilot intervention. Interviews were conducted over the phone or in person and lasted approximately 30 minutes. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes.

Results: TM staff revealed lessons learned they felt were important considerations including: 1) the nurse-patient relationship is central to a successful TM experience, 2) TM is a useful tool for understanding and addressing patient context, 3) TM staff perceive important potential impacts on patient health, and 4) integrating TM into primary care practices needs to be planned carefully.

Conclusions: The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes may be critical to a successful primary care TM model. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are likewise important. Submission History (6 Rejections):

 American Journal of Managed Care- July 2014

o Rejected, with option to shorten to 1000 words and submit as a “Trends in the field” or to submit to another journal “American Journal of Accountable Care”

 JABFM- November 2014

o Paper was revised based on reviewer critiques from the first submit

o Rejected by editors 2 weeks later (no peer review)

 American Journal of Medical Quality- December 2014

o Rejected by editors 1 week later (no peer review)

o Recommended as a good fit for another journal they publish “Population Health Management”

 Joint Commission Journal on Quality and Patient Safety- January 2015

o Rejected by editor because work was “too preliminary” (no peer review)

o Recommended diabetes or TM journal

 Population Health Management- February 2015

o Paper rejected after peer review

o Reviewers felt sample size was too small, not sufficient to be considered as “research”— low validity, generalizability, etc.

 Telemedicine and E-Health- May 2015

o Paper rejected by editors in 18 hours (no peer review) with comment “This is a very well written report which I enjoyed reading. Unfortunately, reports on perceptions are simply no longer receiving sufficient reader interest to allow us to bring them forward. Therefore I am sorry to reject you fine paper.”

o Editor recommended a primary care journal as a home

 Diabetes Educator- May 2015

o Sent email inquiry to editor with the abstract to inquire if article of interest o F/u email sent June 2015--- no response from editor

Next steps????

 DNR??

 Brief report format??

 Primary Health Care Research and Development (UK)

o Have a submission category of “Development Papers”

. Discuss local issues

. Introduction of an innovation

. Matters relating to reflective/developing practice

. Issues of learning and dissemination

. Informs a new area for research

. Addresses issues of evaluation