MITRE Corporation, Health Innovation Center, McLean, Virginia, United States.
Department of Public Health Sciences, Division of Health Informatics, University of California Davis, School of Medicine, Sacramento, California, United States.
Appl Clin Inform. 2023 Aug;14(4):644-653. doi: 10.1055/a-2096-0326. Epub 2023 May 18.
Community health centers and patients in rural and agricultural communities struggle to address diabetes and hypertension in the face of health disparities and technology barriers. The stark reality of these digital health disparities were highlighted during the coronavirus disease 2019 pandemic.
The objective of the ACTIVATE (Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity) project was to codesign a platform for remote patient monitoring and program for chronic illness management that would address these disparities and offer a solution that fit the needs and context of the community.
ACTIVATE was a digital health intervention implemented in three phases: community codesign, feasibility assessment, and a pilot phase. Pre- and postintervention outcomes included regularly collected hemoglobin A1c (A1c) for participants with diabetes and blood pressure for those with hypertension.
Participants were adult patients with uncontrolled diabetes and/or hypertension ( = 50). Most were White and Hispanic or Latino (84%) with Spanish as a primary language (69%), and the mean age was 55. There was substantial adoption and use of the technology: over 10,000 glucose and blood pressure measures were transmitted using connected remote monitoring devices over a 6-month period. Participants with diabetes achieved a mean reduction in A1c of 3.28 percentage points (standard deviation [SD]: 2.81) at 3 months and 4.19 percentage points (SD: 2.69) at 6 months. The vast majority of patients achieved an A1c in the target range for control (7.0-8.0%). Participants with hypertension achieved reductions in systolic blood pressure of 14.81 mm Hg (SD: 21.40) at 3 months and 13.55 mm Hg (SD: 23.31) at 6 months, with smaller reductions in diastolic blood pressure. The majority of participants also reached target blood pressure (less than 130/80).
The ACTIVATE pilot demonstrated that a codesigned solution for remote patient monitoring and chronic illness management delivered by community health centers can overcome digital divide barriers and show positive health outcomes for rural and agricultural residents.
社区卫生中心和农村及农业社区的患者在面临健康差距和技术障碍的情况下，努力解决糖尿病和高血压问题。在 2019 年冠状病毒病大流行期间，这些数字健康差距的严峻现实凸显出来。
ACTIVATE（山谷中实现转型和公平的问责制、协调和远程医疗）项目的目的是共同设计一个远程患者监测平台和慢性病管理方案，以解决这些差距，并提供一个符合社区需求和背景的解决方案。
ACTIVATE 是一个分三个阶段实施的数字健康干预措施：社区共同设计、可行性评估和试点阶段。在干预前后，参与者的糖尿病患者定期采集糖化血红蛋白（A1c），高血压患者定期采集血压数据。
参与者为患有未控制糖尿病和/或高血压的成年患者（n=50）。大多数参与者为白人，西班牙裔或拉丁裔（84%），母语为西班牙语（69%），平均年龄为 55 岁。该技术得到了大量采用和使用：在 6 个月期间，通过连接的远程监测设备传输了超过 10000 次血糖和血压测量值。糖尿病患者的 A1c 在 3 个月时平均降低了 3.28 个百分点（标准差 [SD]：2.81），在 6 个月时降低了 4.19 个百分点（SD：2.69）。绝大多数患者的 A1c 达到控制目标范围（7.0-8.0%）。高血压患者的收缩压在 3 个月时降低了 14.81 毫米汞柱（SD：21.40），在 6 个月时降低了 13.55 毫米汞柱（SD：23.31），舒张压降低幅度较小。大多数患者也达到了目标血压（小于 130/80）。
ACTIVATE 试点表明，由社区卫生中心提供的远程患者监测和慢性病管理共同设计的解决方案可以克服数字鸿沟障碍，并为农村和农业居民带来积极的健康结果。
