The Effects of a Smart Phone App on Hospital Readmission Rates for Patients Diagnosed with Diabetes Thomas Jefferson University School of Nursing, FACT BSN Program A Research Proposal for Partial Completion of Requirements for NU603 Research Design: July-September, 2014 Kevin Abercrombie BSN FACT student, Mary Bouchaud PhD, MSN,CNS, RN, CRRN Assistant Professor Introduction Introduction Introduction Abstract Purpose of the Study To determine effectiveness of CareSmarts mobile phone app along with traditional diabetes education in reducing hospital readmission rates within 30 days of discharge for patients diagnosed with diabetes as compared to using only traditional diabetes education. 30 days chosen as interval due to Medicare reimbursement policy stating that hospitals will not be reimbursed for a re- admission within 30 days for the same diagnosis. Does use of the CareSmarts app decrease hospital readmission rates for diabetic exacerbations in insulin-dependent adults diagnosed with diabetes? If CareSmarts is used by insulin-dependent adults with diabetes then hospital readmission rates will be reduced for acute diabetic exacerbations. 29.1 million diabetics in US, about 9% of the population. 1.7 million diagnosed with diabetes type I or II in 2012. Estimated total costs in 2012 were $245 billion. Poor diabetic control stems from many issues including daily management and a knowledge deficiency of the patients about the disease. With effective lifestyle and treatment plans the onset of complications can be prevented or delayed. Utilizing advanced technology familiar to most people in the United States is one possible avenue to empower patients to improve their disease self-management and reduce hospitalizations and other complications. Diabetes has been a growing concern in the United States due to the rapidly increasing incidence of this disease over the past decade. In their 2014 report, the CDC reported there were 29.1 million people diagnosed with diabetes in 2012, comprising 9.3% of the total US population. In addition, according to the CDC, 1.7 million people were newly diagnosed with type I and type II diabetes in 2012 with health care costs at an estimated $245 billion. Moving forward, the most effective approach is to empower and educate these patients to self-manage their own disease to decrease or prevent acute and chronic complications associated with diabetes. Many studies have been conducted examining the effectiveness of smart phone apps as an educational tool to engage patients in the self-management of their diabetes. These studies measured success based primarily on the subject's hemoglobin A1c. However, the literature was deplete of studies on the effect of smart phone apps on reducing hospital readmission rates for patients diagnosed with diabetes. The aim of this study is to determine if a smart phone app, CareSmarts, utilizing text alerts and educational alerts and educational material is effective in reducing hospital readmission rates related to acute diabetic complications within 30 days of hospital discharge for patients who are insulin-dependent diabetics, newly diagnosed diabetics, and those admitted for an acute diabetic exacerbation. Review of Literature CINAHL was searched using the terms: diabetes, management, phone app, text messaging. 300,000 articles were found which were narrowed down to other quantitative experimental studies. Five were used as the basis for the literature review. CareSmarts app chosen for this study as experimental app from amongst these articles. Majority of studies track effectiveness of smart phone apps in relation to hemoglobin A1c and other laboratory values. Few studies focused on symptoms of diabetes or hospital readmission rates related to acute diabetic illness. Discussion Readmission rates will be analyzed and compared over 30 day span. Phone app tracks use of text service, supply restocking, and educational program use. T-test and Pearson correlation will be used to determine strength of the relationship and if it is significant. Data analysis will also compare effectiveness between demographics of population sample and potential applications to general population. Groups with results significantly differing from general population will be targeted for further study. With diabetes incidence and prevalence increasing annually and health care costs rising a new model of care is needed emphasizing care and management of chronic diseases outside of the hospital. Self-management of disease requires a patient centered approach to tailor care around patient’s life, abilities, and needs. Patient empowerment and involvement in care is the crux of the new health care model. Flexible smart phone apps are a relatively new technology, familiar to most people across the country, with the possibility of meeting these evolving needs in 2014 and beyond. Proposed Methodology The study will be a quantitative experimental 30 day study following 100 patients in both a control group and an experimental group. Alternating randomized sampling based on time of admission to hospital with new onset diabetes or acute glycemic event. Target population will be insulin dependent diabetic adults of any race, gender, socioeconomic class, or education level. Smart phone will be provided for study to all participants without a smart phone. Funding will come from developer of the CareSmarts app. App utilizes three features: Text alert for sugar checks and insulin administration. Texts asking if insulin or supplies are needed. Two educational programs per week covering diabetes, diet, exercise, medication administration, and other management related topics. Potential Study Contribution to Nursing Practice and Patient Education Explores new strategies for patient education utilizing current technology and its effect on reducing hospital readmission rates. Facilitate better outpatient care and management of patients diagnosed with diabetes. Promotes collaboration to enable participation and self-reliance in diabetes management through personalization of smart phone educational and assistive apps such as CareSmarts. Identify deficiencies and strengths of current educational programs for patients diagnosed with diabetes. Serve as basis for further research avenues involving smart phone app use in patient education and patient disease self-management. Summary

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