Date of Graduation

Summer 8-16-2017

Document Type

Project/Capstone

Degree Name

Master of Public Health (MPH)

College/School

School of Nursing and Health Professions

First Advisor

Dhrubajyoti Bhattacharya

Abstract

The following proposal explores a potentially cost effective and cost efficient solution to alleviate the burden of type 2 diabetes among White Memorial Medical Center (WMMC) patients and their primary service area within Los Angeles County Service Planning Area 4 (SPA-4). SPA-4 is a medically underserved area with numerous key health indicators that indicate the need for increased self-management efforts among its Hispanic population. In response, WMMC has made a commitment to the SPA-4 community and made diabetes atop its community priority. An organization-wide Glycemic Control Project was created by WMMC administrators to provide more effective services by using Health Information Technology (HIT) within its operations. In support of this project, the WMMC Clinical Informatics Systems (CIS) department has proposed the use of Healthelife mobile application to improve diabetes self-management in WMMC transitional care. A literature review was conducted but, found very limited efficacy studies on mobile patient portal apps and patient portals mhealth interventions among Hispanic diabetics. However, several studies have implied that there are great research opportunities in tailoring the use of a patient portal mobile application for Hispanics, expanding its use within DMSE sessions through Community Health Workers, utilizing the trending mhealth functionality of patient portals, as well as proposing eHealth interventions that reduce health disparities. As a newly available resource to WMMC, the Healthelife mobile application is Cerner’s multilingual patient portal mobile application that is already live and fully integrated with WMMC’s “My Adventist Health” patient portal”. Accordingly, WMMC CIS has proposed a HealtheLife pilot program among its Hispanic patients to determine if its use will improve self-management efficacy and glycemic control among WMMC Type 2 diabetics (18+ years old). Technological Acceptance Model (TAM), Social Support, and Social Cognitive Theory will be applied throughout the pilot to gradually condition Healthelife usage among WMMC patients/caregivers for tailored educational experiences that strengthen WMMC Diabetes Self-Management (DSME) sessions. Essentially, diabetes educators will conduct the pilot program on adult Hispanics (18+) who are inpatient diabetics transitioning to Adventist Health Physician Network (AHPN) Physicians and DSME outpatient services. Primarily, the pilot will aim to improve A1Cs, Self-efficacy, and DSME attendance. Secondary outcomes of the intervention will be asses by qualitative assessment of Healthelife functionality, observed ED use, and ED readmission. All outcomes will be assessed through an internal quasi-experimental study examining an intervention group using Healthelife against a retrospective control groups from 2016. In sum, goal of the pilot program will set forth a care path that improve patients’ continuity of care and diabetes prevention beyond the walls of WMMC operations. By adopting the use of Healthelife as a population health tool, WMMC has the potential to intensify current DSME curriculum, to preventative unnecessary ED use, and to improve type 2 diabetes prevention efforts within SPA-4. More importantly, the suggestion to pilot Healthelife progressively introduces the benefits of HIT to Hispanic populations who are underserved and with limited resources.

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