• J D Piette, M Weinberger, and S J McPhee.
• Center for Health Care Evaluation/HSR&D Field Program, VA Palo Alto Health Care System, CA 94025, USA. piette@odd.stanford.edu
• Med Care. 2000 Feb 1; 38 (2): 218-30.

ObjectiveWe evaluated the impact of automated telephone disease management (ATDM) calls with telephone nurse follow-up as a strategy for improving outcomes such as mental health, self-efficacy, satisfaction with care, and health-related quality of life (HRQL) among low-income patients with diabetes mellitus.Research DesignThis was a randomized, controlled trial.SubjectsTwo hundred forty-eight primarily English- and Spanish-speaking adults with diabetes enrolled at the time of visits to a county health care system.InterventionIn addition to usual care, intervention patients received biweekly ATDM calls with telephone follow-up by a diabetes nurse educator. Patients used the ATDM calls to report information about their health and self-care and to access self-care education. The nurse used patients' ATDM reports to allocate her time according to their needs.MeasuresPatient-centered outcomes were measured at 12 months via telephone interview.ResultsCompared with patients receiving usual care, intervention patients at follow-up reported fewer symptoms of depression (P = 0.023), greater self-efficacy to conduct self-care activities (P = 0.006), and fewer days in bed because of illness (P = 0.026). Among English-speaking patients, those receiving the intervention reported greater satisfaction with their health care overall and with the technical quality of the services they received, their choice of providers and continuity of care, their communication with providers, and the quality of their health outcomes (all P <0.042). Intervention and control patients had roughly equivalent scores for established measures of anxiety, diabetes-specific HRQL, and general HRQL.ConclusionsThis intervention had several positive effects on patient-centered outcomes of care but no measurable effects on anxiety or HRQL.

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