Reinventing The House Call

The U.S. government is teaming up with several hospitals to bring health care into rural and inner city homes where residents have diabetes.

Dr. Steven Shea of Columbia University, who is leading the program, says the project will feature phone and computer networks.

The program will begin in New York State and could be expanded if it's a success.

Columbia University College of Physicians and Surgeons at Columbia Presbyterian Medical Center and SUNY Upstate Medical University are using a $28 million government grant.

The effort, dubbed Informatics for Diabetes Education and Telemedicine, is being funded by U.S. Department of Health and Human Services' Health Care Finance Administration, which also provides money for Medicare.

The study will enroll 1,500 diabetes patients from Harlem and other parts of northern Manhattan and rural areas of central and upstate New York, places where quality, affordable health care is often hard to find.

Half of the patients will be given computers and be trained to use them to read blood sugar, take pictures of skin and feet and check blood pressure. The rest continue with their current health care.

Shea said there were several questions that they hope the program will answer.

Is it cost effective for the federal government to reimburse health care providers for providing service electronically rather than face to face?

Can patients get better care at a lower cost without having to visit the doctor's office often?

Can doctors be more effective in preventing complications from diabetes, like heart disease, cataracts or kidney disease, if cyber-medicine is part of a diabetic's health care regimen?

"I think that the success of the project will depend on answering all those questions well and using those answers to make good health care practices and policy," said Shea.

"This 'house call' of the future will allow patients and clinicians to reach out across any distance for care," he said.

In New York State alone, about 1.6 million people suffer from diabetes. Complications from the disease cost the U.S. economy about $45 billion each year, with an additional $47 billion attributed to indirect costs from diabetes-related disabilities.

Diabetes can be treated and the complications staved off, but it requires daily management. People living in rural areas and the poor often cannot afford this kind of treatment or are poorly educated about how to handle the disease.

Patients who are chosen for the four-year project will begin enrolling in six months and will be part of the study for two years.

A number of other hospitals, associations and health care providers will be joining Columbia and SUNY Upstate Medical University in the project.