1. Association of technologically assisted integrated care with clinical outcomes in type 2 diabetes in Hong Kong using the prospective JADE Program: A retrospective cohort analysis.
- Author
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Lim LL, Lau ESH, Ozaki R, Chung H, Fu AWC, Chan W, Kong APS, Ma RCW, So WY, Chow E, Cheung KKT, Yau T, Chow CC, Lau V, Yue R, Ng S, Zee B, Goggins W, Oldenburg B, Clarke PM, Lau M, Wong R, Tsang CC, Gregg EW, Wu H, Tong PCY, Ko GTC, Luk AOY, and Chan JCN
- Subjects
- Adult, Cohort Studies, Female, Hong Kong epidemiology, Humans, Male, Middle Aged, Program Evaluation, Proportional Hazards Models, Registries, Retrospective Studies, Risk Factors, Self Care methods, Treatment Outcome, Delivery of Health Care, Integrated statistics & numerical data, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 epidemiology
- Abstract
Background: Diabetes outcomes are influenced by host factors, settings, and care processes. We examined the association of data-driven integrated care assisted by information and communications technology (ICT) with clinical outcomes in type 2 diabetes in public and private healthcare settings., Methods and Findings: The web-based Joint Asia Diabetes Evaluation (JADE) platform provides a protocol to guide data collection for issuing a personalized JADE report including risk categories (1-4, low-high), 5-year probabilities of cardiovascular-renal events, and trends and targets of 4 risk factors with tailored decision support. The JADE program is a prospective cohort study implemented in a naturalistic environment where patients underwent nurse-led structured evaluation (blood/urine/eye/feet) in public and private outpatient clinics and diabetes centers in Hong Kong. We retrospectively analyzed the data of 16,624 Han Chinese patients with type 2 diabetes who were enrolled in 2007-2015. In the public setting, the non-JADE group (n = 3,587) underwent structured evaluation for risk factors and complications only, while the JADE (n = 9,601) group received a JADE report with group empowerment by nurses. In a community-based, nurse-led, university-affiliated diabetes center (UDC), the JADE-Personalized (JADE-P) group (n = 3,436) received a JADE report, personalized empowerment, and annual telephone reminder for reevaluation and engagement. The primary composite outcome was time to the first occurrence of cardiovascular-renal diseases, all-site cancer, and/or death, based on hospitalization data censored on 30 June 2017. During 94,311 person-years of follow-up in 2007-2017, 7,779 primary events occurred. Compared with the JADE group (136.22 cases per 1,000 patient-years [95% CI 132.35-140.18]), the non-JADE group had higher (145.32 [95% CI 138.68-152.20]; P = 0.020) while the JADE-P group had lower event rates (70.94 [95% CI 67.12-74.91]; P < 0.001). The adjusted hazard ratios (aHRs) for the primary composite outcome were 1.22 (95% CI 1.15-1.30) and 0.70 (95% CI 0.66-0.75), respectively, independent of risk profiles, education levels, drug usage, self-care, and comorbidities at baseline. We reported consistent results in propensity-score-matched analyses and after accounting for loss to follow-up. Potential limitations include its nonrandomized design that precludes causal inference, residual confounding, and participation bias., Conclusions: ICT-assisted integrated care was associated with a reduction in clinical events, including death in type 2 diabetes in public and private healthcare settings., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: JCNC is the Chief Executive Officer (on a pro-bono basis) of ADF, a charitable foundation established under the CUHK Foundation for developing the JADE Technology. JCNC, WYS, and RCWM are co-founders of GemVCare, a biotechnology company, supported by the Hong Kong Government Technology Start-up Support Scheme for Universities, which licenses the JADE Technology to provide diabetes risk evaluation and management program, in collaboration with other healthcare organizations. RCWM is a member of the editorial board for PLOS Medicine. RCWM has received research grants for clinical trials from AstraZeneca, Bayer, MSD, Novo Nordisk, Sanofi, and Tricida and honoraria for consultancy or lectures from AstraZeneca and Boehringer Ingelheim.
- Published
- 2020
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