Family Nurse Practitioner Marva Ortiz-Wade teaches a diabetes education class at KCHC

Not long ago, Margaret Orosco had an alarmingly high hemoglobin A1c blood sugar level of 12.5 % as well as high cholesterol and blood pressure, both side effects from her diabetes. But thanks to the Telehealth program and doctors and nurses at Kings County Hospital Center, Orosco has lowered her A1c level to a well-controlled level of 6.9% in just nine months.

“Being referred to Telehealth changed my life,” Orosco said. “The nurses at the other end of this telemonitoring system have taught me how to manage my diabetes, which has brought my blood sugar level down over five percentage points since March of this year. I feel healthier and more involved in my own personal health than ever before.”

The Telehealth program is part of a new trend of telemedicine and e-health initiatives that connect patients with their healthcare providers through new technologies.  At Kings County and across HHC, patients who are having trouble self-managing their disease are connected to a cadre of trained nurse professionals through an electronic remote monitoring system.

Patients are given a glucometer that connects to a telephone modem the size of a flip phone. Installed in the patient’s home, the equipment is used to measure blood sugar, weight, and blood pressure and then the information is sent to HHC Health & Home Care nurses with the push of a button via the program's toll free phone line. Readings that are outside acceptable levels trigger automatic alerts which prompts a nurse to work with the patient and guide them back to controlled levels before a health crisis occurs.

Orosco isn’t the only Kings County patient who has made great strides. Among the 147 patients from Kings County and the Central Brooklyn Family Health Network that were enrolled in Telehealth between October 2007 and January 2010, the average value of their A1c levels before enrollment in the program was 9.7%. The average value of their A1c levels post participation in Telehealth for at least one year was 8.0% -- a significant reduction, bringing the group much closer to the desired 7% that marks healthy control.

“We were surprised to see how well our patients did on Telehealth in such a short amount of time,” said Roslyn Weinstein, Acting Executive Director of Kings County Hospital Center. “This self management program is a perfect example of the kind of patient-centered care that is happening at our facilities. The program empowers the patients and holds them accountable for their health and well-being on a daily basis.”

Because of the success that Kings County has seen with its Telehealth patients, hospital staff members are taking a more proactive approach with referrals and regularly search the primary care clinic patient registry to find patients who suffer from poorly managed diabetes and link them to this telemedicine program.

"Our referrals and enrollees to the program have almost tripled in the last year,” said Dr. Joseph Williams, Director of Adult Primary Care at Kings County.

Due to the increase in referrals from Kings County, Marva Ortiz-Wade, a Family Nurse Practitioner and certified diabetes educator with the Telehealth program now visits Kings County once a week to meet with patients and explain the program, answer questions and expedite the enrollment process. Nurse Ortiz-Wade also works directly with physicians on care management and explains the value of the Telehealth program and what it can do for patients.

“At first some patients are hesitant to join the program,” said Ortiz-Wade. “But once I sit down with them and explain how easy it is to send their levels through the device, how reassuring it is to know there’s someone at the other end who cares and is following their progress, they quickly recognize the benefits and get on board to become an active participant in their daily health.”

The Telehealth program isn’t the only strategy the Kings County medical providers have adopted to help patients with diabetes.  The hospital also has a comprehensive Diabetes Education Program that’s recognized by the American Diabetes Association, where certified diabetes educators host sessions on topics like nutrition, exercise, monitoring, and coping with the condition. The classes are available in English and Spanish.

Each year, Kings County holds a graduation ceremony for patients who have completed the diabetes education sessions. This past June, the program had over 120 graduates.

March 2012