How can primary care help patients with physical disabilities, who also deal with type 2 diabetes and other chronic disease, best manage their health? A team spearheaded by the UAB Department of Family and Community Medicine will soon be conducting a real-world trial comparing effectiveness of primary care-based telehealth options in hopes of answering that question so patients, physicians, and caregivers can make informed decisions about their care.

Using more than $11.4 million in funding by the Patient-Centered Outcomes Research Institute (PCORI), the multisite study will compare the effectiveness of digital health coaching, remote patient monitoring, and a combination of these options for improving blood sugar levels in people living with physical disabilities, type 2 diabetes, and at least one other cardiometabolic or cardiorenal comorbidity, such as hypertension, congestive heart failure, coronary artery disease, cancer, or chronic kidney disease.

“There is a well-documented relationship among physical disabilities, diabetes, and chronic conditions. Research shows that those living with both chronic diseases and physical disabilities are at a substantially increased risk for poor health status and life satisfaction, making it even harder to effectively manage their chronic conditions,” explained Department of Family and Community Medicine Vice Chair of Research Tapan Mehta, Ph.D., the study’s principal investigator. “Interventions based in primary care to help manage chronic conditions in people with physical disabilities need to address suboptimal social determinants of health. This is especially true in the Deep South, where the intersectionality of race and rurality also needs to be accounted for.”

The study — “Optimizing Effectiveness of Primary Care Delivered Telehealth Interventions to Manage Type 2 Diabetes in People with Physical Disabilities and Multiple Chronic Conditions” — reflects the department’s research strategy, which focuses on high-impact primary care research that is patient- and community-centered, including work that enhances health promotion, improves care for chronic diseases, and advances health care delivery.

“We’ve been very strategic in looking for funding opportunities that align to the Quintuple Aim to improve patient experience and provider experience, improve population health outcomes, reduce cost, and promote health equity,” said Mehta. “Our goal in research is to serve patients and communities while looking at how we can learn, innovate, and advance delivery to improve primary care for people with disabilities in managing chronic disease. Our motivation to respond to PCORI’s call about Telehealth to Optimize Management of Multiple Chronic Conditions among vulnerable populations in primary care was very intentional, and we are excited to have this opportunity to generate rigorous evidence in pragmatic primary care settings.”

UAB’s study was selected through a PCORI Funding Announcement focused on research comparing different approaches to incorporating access to and use of telehealth in primary care to improve outcomes among individuals with multiple chronic conditions, particularly among underserved populations. While the COVID-19 pandemic led to a rapid expansion in the use of telehealth, questions remain about the most effective, evidence-based ways to incorporate telehealth modalities as part of routine clinical workflow to facilitate chronic disease management and mitigate health disparities. This study has assembled an impressive team comprising investigators from UAB’s Heersink School of Medicine and schools of Public Health, Nursing, and Health Professions, collaborators from health systems across the Deep South, and a panel of patients, caregivers, providers, and payors.

Telehealth programs, including digital health coaching and remote patient monitoring, are increasingly being used, especially for those who otherwise have limited access to in-person health care. However, more information is needed to demonstrate which option — or a combination of these interventions — is the most effective and how they affect long-term outcomes among those with physical disabilities and multiple chronic conditions.

This trial will randomly divide qualified participants into three groups to test different interventions for six months.

Those receiving remote patient monitoring (RPM), will have a health care team checking and managing their blood sugar remotely. To make this easier for participants, they will be provided the necessary devices and a mobile WiFi data plan to transmit the data, eliminating the need for internet connectivity. If a patient’s blood sugar remains elevated for a long period of time, a registered nurse and health care provider will offer guidance and support.

A second group will receive digital health coaching, which involves one-on-one weekly phone calls with a health coach. This approach offers personalized support and guidance for participants on managing type 2 diabetes, including advice on nutrition, exercise, and taking medications.

Finally, a third group will receive a combination of both the remote patient monitoring and digital health coaching programs.

This multisite trial will partner with health systems across the Deep South — UAB, the University of Mississippi Medical Center, and LSU Health. Alabama, Mississippi, and Louisiana currently rank near the bottom of all states for health outcomes (45, 46, and 48 respectively) and have some of the country’s highest rates of diabetes and multiple chronic illnesses, according to America’s Health Rankings.

“This study was selected for PCORI funding for its potential to answer the need for real-world evidence about how best to incorporate telehealth into the primary care of people with multiple chronic conditions, and how this may differ among populations at risk for health disparities,” said PCORI Executive Director Nakela L. Cook, M.D., MPH. “We look forward to following the study’s progress and working with UAB to share the results.”

This award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.