???Through telemedicine, we???re providing crucial diabetes care to patients in rural areas and giving them the tools they need to better manage their diabetes.??? - Tammie Payne, RN, MS, CDE, UPMC Bedford Memorial


Grant Application

Tammie Payne, RN, MS, CDE, UPMC Bedford Memorial in partnership with Linda Siminerio, RN, PhD, CDE


Proposed Innovation

Address limited access to team-based care and support for diabetes patients in rural communities by introducing shared decision-making materials (SDM) and aids. Team-based care has proven to be the best predictor for improvements in glucose control. For many patients in outlying areas, telemedicine is their first exposure to team care and to an active role in decision making.


Improvements in Action

The team is designing, producing and implementing shared decision-making aids and training-program materials to help patients manage glucose and related lifestyle considerations. Patients and providers will be shown how to engage as a team despite being located at multiple sites. Program fidelity will be ensured through supervision of shared decision- making approaches during telemedicine visits.


Results – In Progress

The health care team has been trained on the shared decision-making process. In addition, the SDM process and aids have been successfully integrated and implemented into telemedicine visits with diabetes patients. Patients and providers report that they find the aids useful in communicating the meaning of HbA1C levels (a measure of glucose control), as well as the benefits and risks of glucose control.

Participants also report that the tools helped facilitate conversations between team members and patients, and enhanced patient behavioral goal setting. Although it cannot be directly associated with SDM, HbA1C levels have improved significantly. In addition, patients say they have a better understanding of diabetes and feel empowered. Follow up data is being collected and analyzed.

As a result of the progress experienced to date, the model has been expanded to another telemedicine site (UPMC Northwest) and has been adapted for use by the Endocrine Diabetes Center (Falk Clinic). The telemedicine project was recently featured on local television news and will be presented at a national diabetes convention.