Health Service Utilization Implications of a Mobile Diabetes Health Intervention (Preprint)

BACKGROUND Type 2 diabetes is a major chronic condition requiring management through lifestyle changes and recommended health service visits. Mobile health is a promising tool to encourage self-management, but few studies have investigated the impact of mobile health on health care utilization. OBJECTIVE In the current analysis, we aimed to determine change in two-year health service utilization and whether utilization explained a 1.9% absolute decrease in HbA1c over one-year in the Mobile Diabetes Intervention Study (MDIS). METHODS We used commercial claims data from 2006-2010 linked with enrolled patients’ medical chart data in 26 primary care practices in Maryland. Secondary claims data analysis was available for 56% of participants (n=92). In the primary MDIS study, physician practices were recruited and randomized to usual care and one of three increasingly complex interventions. Patients followed physician randomization assignment. Main variables in the analysis include health service utilization by type of service and change in HbA1c. The claims data was aggregated into 12 categories of utilization to assess change in two-year health service utilization. We also examined whether utilization explained the 1.9% decrease in HbA1c over one-year in a mobile diabetes cluster randomized clinical trial. RESULTS A significant group by time effect was observed in physician office visits (P<.001), general practitioner visits (P<.001), other outpatient services (P=.009), and prescription medications (P<.001). No significant effects of utilization were observed to explain clinically significant change in HbA1c. CONCLUSIONS Claims data analyses identified patterns of utilization relevant to mobile health interventions. Findings may encourage patients and health providers to discuss utilization of treatment-recommended services, lab tests, and prescribed medications.