Accelerate AHEAD Study: Evaluating Diabetes Technology Use in Primary Care

The SARS-CoV-2 disease (COVID-19) pandemic, which began in the US in early March 2020, led Centers for Medicare and Medicaid (CMS) and others to reimburse telehealth at the same rate as in-person encounters, ushering in a new age of health care delivery through technology to address critical care gaps. Patients with diabetes mellitus (DM) have been particularly affected, since they are at higher risk of COVID-19 morbidity, and since many DM clinical teams have replaced in-person encounters with telehealth. Even prior to COVID-19, DM accounted for over $245 billion in annual healthcare costs with significant costs attributed to hospitalization, non-adherence, and poor self-care, with large disparity gaps identified. The efficacy of telemedicine and remote technology such as continuous glucose monitoring (CGM) in DM care has improved care even more so during COVID-19, but widespread use of CGM and telehealth even when covered remains low. Thus, there remains a large translational gap between the evidence base of improvement in outcomes with technologies in DM care and real-world use, especially in primary care in which the majority of people with diabetes are cared. The care gap is magnified in underserved populations with DM with major preventable inequities in outcomes. We propose to comprehensively identify current care gaps and use the data to inform acceleration of solutions to increase use of telehealth or remote care delivery in underserved populations. While researchers are developing technologically driven DM care interventions that could mitigate care gaps to reduce disparities, there are major implementation barriers to adoption. This proposal seeks to capitalize on existing infrastructure at 2 leading CDTRs (National Accelerating Health Equity And Eliminating Diabetes Disparities in Community Health Centers [AHEAD-CHC] Core at Chicago Center for Diabetes Translation Research [CCDTR], and the Behavioral Science and Technology Core at New York Regional Center for Diabetes Translation Research [NY Regional CDTR]) to characterize current technology use in DM care delivery in a large network of federally qualified health centers in the United States, and use qualitative and stakeholder engagement methods to identify barriers and accelerate implementation of ongoing DM technology interventions to real-world care settings that will rapidly improve DM health care delivery and outcomes.