PLoS Medicine (Oct 2020)

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.

  • Lee-Ling Lim,
  • Eric S H Lau,
  • Risa Ozaki,
  • Harriet Chung,
  • Amy W C Fu,
  • Wendy Chan,
  • Alice P S Kong,
  • Ronald C W Ma,
  • Wing-Yee So,
  • Elaine Chow,
  • Kitty K T Cheung,
  • Tiffany Yau,
  • C C Chow,
  • Vanessa Lau,
  • Rebecca Yue,
  • Shek Ng,
  • Benny Zee,
  • William Goggins,
  • Brian Oldenburg,
  • Philip M Clarke,
  • Maggie Lau,
  • Rebecca Wong,
  • C C Tsang,
  • Edward W Gregg,
  • Hongjiang Wu,
  • Peter C Y Tong,
  • Gary T C Ko,
  • Andrea O Y Luk,
  • Juliana C N Chan

DOI
https://doi.org/10.1371/journal.pmed.1003367
Journal volume & issue
Vol. 17, no. 10
p. e1003367

Abstract

Read online

BackgroundDiabetes 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 findingsThe 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 ConclusionsICT-assisted integrated care was associated with a reduction in clinical events, including death in type 2 diabetes in public and private healthcare settings.