P-158: Factors associated with remote patient monitoring messaging engagement for youth with type 1 diabetes and their families
M Y Lee, V Ritter, B Shaw, F Bishop, R Tam, R Johari, D Scheinker, D Maahs, P PrahaladAbstract
Introduction
Remote patient monitoring (RPM) of youth with type 1 diabetes (T1D) increases touchpoints for insulin dose adjustments and diabetes education. Stanford Children’s offered two continuous glucose monitor-based RPM programs to support youth with T1D. The 4T Program supported youth during the first year of T1D diagnosis, whereas TIPS supported youth with established T1D and public insurance.
Objectives
We aim to assess the factors associated with engagement with a patient portal RPM.
Methods
Participant demographics and RPM messages from clinicians to participants obtained from the electronic health records. Not reading messages within 7 days was used as a marker of non-engagement. Rate ratios (RRs) were estimated using message-level data and Poisson regression. Exposures of interest included insurance type, preferred language, racial background, age at enrollment, and duration in study. Estimates were adjusted for study cohort.
Results
The analytic data set included 282 participants and 5232 RPM messages (Figure 1). Participants from TIPS had the highest rate of non-engagement (38% TIPS vs 11% Pilot 4T vs 12% 4T Study 1, p-value <0.001). Non-engagement with RPM differed between cohorts (TIPS vs Study 1: RR 2.9; 95% CI 2.1-4.0; p<0.001). After adjusting for cohort, non-engagement was associated with non-English speakers (RR 1.5; 95% CI 1.0, 2.1; p=0.03), public insurance (RR 1.7; 95% CI 1.2, 2.6; p=0.009), and study month (RR 1.05; 95% CI 1.03, 1.07; p<0.001).
Conclusions
We demonstrate associations between insurance status, preferred language, and duration of enrollment in RPM with the families’ engagement with patient portal RPM. Lower engagement with RPM leads to fewer opportunities to address concerning glycemic trends and behavior patterns identified by clinicians. We need to explore alternative communication methods that promote engagement and promote equity in diabetes care.