ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Will a telehealth initiative improve poorly controlled type 2 diabetes mellitus (DM) and unmet social determinants of health (SDOH) needs exacerbated by the COVID-19 pandemic? DESCRIPTION OF PROGRAM/INTERVENTION: Due to COVID-19, many patients with DM faced challenges accessing healthcare, as well as exacerbations of socioeconomic disparities regarding access to food, affordable housing, and safe places to exercise. To address these challenges, we adapted an existing student-faculty collaborative practice at Beth Israel Deaconess Medical Center, Boston, MA, to a telehealth platform to provide targeted DM management, and referrals to dietitians and community resource specialists. MEASURES OF SUCCESS: We assessed clinical outcomes, such as changes in hemoglobin A1c (HbA1c), LDL, and number of medication adjustments. Measured quality indicators included frequency of HbA1c, LDL, and microalbuminuria measurements, as well as prescription of cardiovascular/diabetic medications such as ACE inhibitors, statins, and aspirin within the year prior to enrollment and within 6 months after the final visit. To measure the role and intervenability of SDOH needs, we tracked the results of SDOH screens to identify key needs, as well as the number of dietitian and community resource specialist (CRS) referrals placed. FINDINGS TO DATE: Of 998 patients with non-insulin-dependent type 2 DM, 60 were enrolled in the program, of whom 42% were white and had a median BMI of 32.0 kg/m2 (IQR 28.3-36.1). Patients endorsed high motivation (8/10) and confidence (7/10) in managing their diabetes, but reported inadequate nutrition education (56.7% of cohort), as well as difficulty maintaining a healthy diet (76.7%) and exercising (78.3%). Analysis of baseline data and for those who completed the program thus far (n = 22, >6 months since last clinic visit), showed a significant decrease in mean HbA1c (mean ±SEM) from 8.72±0.15 to 8.09±0.22 (p = 0.03). LDL levels were not significantly different before and after the program, 90.3±5.4 vs 100.9±10.6 (p = 0.42). Lab draw frequency (HbA1c, LDL) and medication prescription (ACE inhibitors, statin, aspirin) and were not significantly different. Of patients who completed the program, 8 (36.4%) had their diabetes medications adjusted. 2 (9.1%) were referred to a CRS, and 2 (9.1%) were referred to a dietitian. KEY LESSONS FOR DISSEMINATION: Our ongoing study showed that the implementation of a telehealth diabetes program with SDOH screening can be an effective way to assist patients with uncontrolled diabetes. We identified significant patient needs for additional support and clinical care. Assessing socioeconomic burdens faced by patients and understanding the impact and key features of such a collaborative telehealth program can pave the way for the implementation of a similar model of care for other chronic conditions.
ABSTRACT
Purpose: The Covid crisis led to a huge worldwide shift in consumer behavior. In response, Walmart’s revised business strategy promoted their online delivery service known as Walmart Plus. This study aims to critique the potential of this new venture via a customer value analysis. Design/methodology/approach: Using the customer value funnel, Walmart’s market environment, organizational factors, customer perceptions and business performance are examined. An exploratory survey collected data from South Florida residents on awareness and interest in Walmart Plus. Findings: The changing marketplace forced Walmart to quickly adapt to online buyers and emphasize the value of their retail and grocery products. Walmart Plus is an alternative to Amazon Prime and can assist the company gain market share in regional grocery markets. Research limitations/implications: This work is largely conceptual and presents a case study featuring a limited sample in one metropolitan statistical area. While the findings are insightful, it may not be representative of the US market. Practical implications: Corporate executives and entrepreneurs must respond to changing market conditions and rethink their business models to deliver superior customer value. This requires introducing innovative services and digital initiatives to compete successfully. The paper concludes with recommendations for management and questions for consideration. Originality/value: Walmart is the dominant American retailer and a global leader. While there has been considerable research on this retail giant, there has been limited analysis of their digital initiatives such as Walmart Plus. © 2021, Emerald Publishing Limited.
ABSTRACT
Background: While almost every provider and the majority of patients in the United States (US) possess the technology needed to conduct a telemedicine visit, prior to the current pandemic utilization in home dialysis was relatively low. The current study examined trends in telehealth utilization before and during the COVID-19 pandemic in US home dialysis patients treated by a large dialysis organization in the US. Methods: Telehealth was delivered using a proprietary multiparty, video, secure messaging (HIPAA compliant), scheduling, and educational resource telehealth platform DaVita Care Connect™ (DCC™) application. IT systems data were utilized to develop ongoing reports depicting patient, facility, and physician adoption rates across 1750 home dialysis programs. Data were segmented by geographic areas (9) and by time of COVID-19 dissemination within locales. Results: A meaningful increase in telehealth utilization was observed since the start of the pandemic (prior to March 2020). Among 28,500 home dialysis patients treated, the DCC™ application was installed on 18,300 patient cell phones (65.3%). Overall, 16,000 peritoneal dialysis (PD) patients and 2,200 home hemodialysis (HHD) patients participated in a telehealth visit. Fifteen thousand visits were performed in April 2020. There were 18,000 messages sent between the care team and patient and 6000 educational resources viewed by patients at home since the COVID-19 pandemic (mid-March). The numbers of social worker and dietician visits and interdisciplinary team rounds also increased over time. There was significant variation DCC™ app download and utilization across geographic regions. Conclusions: The COVID-19 pandemic has dramatically increased the use of telehealth management for home dialysis patients in the US. Examining the impact of virtual visits on patient outcomes going forward will be critical in designing post-COVID care. Balancing the integration of telehealth visits and face-to-face visits to optimize care will necessitate advancing a new care model for patients with end-stage kidney disease.