Skip to main content
Log in

Information Technology to Support Self-Management in Chronic Care

A Systematic Review

  • Review Article
  • Published:
Disease Management & Health Outcomes

Abstract

Informed individuals who are actively engaged in managing the daily challenges of their chronic disease are the change agents in a healthcare system that is presently unresponsive to the needs of this growing population. The application of information technology (IT) to support self-management extends the reach of the provider organization by linking patients to the exchange of health information and facilitating self-management activities. This systematic review of the literature was conducted to illuminate the application of IT that is enabling consumer self-management and healthcare provider support of that self-management. Research in self-management IT is being conducted to determine the effectiveness of various tools in improving self-management performance and health outcomes. A significant area of inquiry focuses on self-management technologies to support the chronic care model (CCM) conceived by Wagner and colleagues.

Results indicate that most research is focused on the use of IT by individuals for self-education and self-monitoring, with a small number of studies exploring applications to enable collaboration of providers and individuals in self-management planning and activities. Changes in patient adherence and levels of knowledge were the most popular outcome variables measured, with reports of significant improvements in both areas. However, limitations in study design have led to inconclusive results regarding the effect of IT-based self-management tools on patient adherence and clinical outcomes. This systematic review affirms the importance of extending the IT infrastructure of the healthcare system to support the self-management activities of individuals striving to manage their chronic disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I
Table II
Fig. 1
Table III
Table IV
Table V

Similar content being viewed by others

References

  1. Partnership for Solutions. Chronic conditions: making the case for ongoing care [online]. Available from URL: http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf [Accessed 2006 Jan 3]

  2. Wagner EH, Davis C, Schaefer J, et al. A survey of leading chronic disease management programs: are they consistent with the literature?. J Nurs Care Qual 2002; 16(2): 67–80

    Article  Google Scholar 

  3. Wagner EH, Bennett SM, Austin BT, et al. Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med 2005; 11 Suppl. 1: 7–15

    Google Scholar 

  4. Wolff JL, Boult C. Moving beyond round pegs and square holes: restructuring Medicare to improve chronic care. Ann Int Med 2005; 143(6): 439–45

    PubMed  Google Scholar 

  5. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002 Oct; 288(14): 1775–9

    Article  PubMed  Google Scholar 

  6. Herzlinger RE. Market-driven health care: who wins, who loses in the transformation of America’s largest service industry. Reading (MA): Addison-Wesley, 1997

    Google Scholar 

  7. Hill-Briggs F. Problem-solving in diabetes self-management: a model of chronic illness self-management behavior. Ann Behav Med 2003; 25(3): 182–93

    Article  PubMed  Google Scholar 

  8. Shortell SM, Gillies RR, Anderson DA, et al. Remaking health care in America: the evolution of organized delivery systems. 2nd ed. San Francisco (CA): Jossey-Bass, 2000

    Google Scholar 

  9. Gingrich N, Pavey D, Woodbury A. Saving lives and saving money: transforming health and healthcare. Washington, DC: The Alexis de Tocqueville Institution, 2003

    Google Scholar 

  10. Jackson CL, Bolen S, Broncati FL, et al. A systematic review of interactive computer-assisted technology in diabetes care. J Gen Intern Med 2006; 21(2): 105–10

    PubMed  Google Scholar 

  11. Murray E, Burns J, See TS, et al. Interactive health communication applications for people with chronic disease. Cochrane Database Syst Rev 2005; (4): CD004274

  12. Pare G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc 2007; 14(3): 269–75

    Article  PubMed  Google Scholar 

  13. Wagner EH, Austin BT, Davis C, et al. Improving chronic illness care: translating evidence into action. Health Aff 2001; 20(6): 64–78

    Article  CAS  Google Scholar 

  14. Creswell JW. Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks (CA): Sage Publications, 1998

    Google Scholar 

  15. Hibbard JH. Moving toward a more patient-centered health care delivery system. Health Aff (Millwood) 2004; Suppl Web Exclusives: VAR133-5

  16. Bodenheimer T, Lorig K, Holman H, et al. Patient self-management of chronic disease in primary care. JAMA 2002 Nov; 288(19): 2469–75

    Article  PubMed  Google Scholar 

  17. Rothman AA, Wagner EH. Chronic illness management: what is the role of primary care?. Ann Int Med 2003; 138(3): 256–62

    PubMed  Google Scholar 

  18. Hibbard JH, Tusler M. Assessing activation stage and employing a ‘next steps’ approach to supporting patient self-management. J Ambul Care Manage 2007; 30(1): 2–8

    PubMed  Google Scholar 

  19. Mosen DM, Schmittdiel J, Hibbard J, et al. Is patient activation associated with outcomes of care for adults with chronic conditions?. J Ambul Care Manage 2007; 30(1): 21–9

    PubMed  Google Scholar 

  20. Dorr DA, Wilcox A, Burns L, et al. Implementing a multidisease chronic care model in primary care using people and technology. Dis Manag 2006; 9(1): 1–15

    Article  PubMed  Google Scholar 

  21. MacLean CD, Littenberg B, Gagnon M. Diabetes decision support: initial experience with the Vermont diabetes information system. Am J Public Health 2006; 96(4): 593–5

    Article  PubMed  Google Scholar 

  22. Montori VM, Dineen SF, Gorman CA, et al. The impact of planned care and a diabetes electronic management system on community-based diabetes care. Diabetes Care 2002; 25(11): 1952–7

    Article  PubMed  Google Scholar 

  23. Campion FX, Tully GL, Barrett J, et al. Improving quality of care using a diabetes registry and disease management services in an integrated delivery network. Dis Manage 2005; 8(4): 245–52

    Article  Google Scholar 

  24. Deo SS, Deobagkar DN, Deobagkar DD. Design and development of a web-based application for diabetes patient data management. Inform Prim Care 2005; 13: 35–43

    PubMed  CAS  Google Scholar 

  25. Mohler PJ, Mohler NB. Improving chronic illness care: lessons learned in private practice. Fam Pract Manag 2005; 12(10): 50–6

    PubMed  Google Scholar 

  26. Chima CS, Farmer-Dziak N, Cardwell P, et al. Use of technology to track program outcomes in a diabetes self-management program. J Am Diet Assoc 2005; 105(12): 1933–8

    Article  PubMed  Google Scholar 

  27. Hatzakis MJ, Allen C, Haselkorn M, et al. Use of medical informatics for management of multiple sclerosis using a chronic care model. J Rehabil Res Dev 2006; 43(1): 1–16

    Article  PubMed  Google Scholar 

  28. Goldberg HI, Ralston JD, Hirsch IB, et al. Using an internet comanagement module to improve the quality of chronic disease care. Jt Comm J Qual Saf 2003; 29(9): 443–51

    PubMed  Google Scholar 

  29. Barrera M, Glasgow RE, McKay HG, et al. Do internet-based support interventions change perceptions of social support? An experimental trial of approaches for supporting diabetes self-management. Am J Community Psychol 2002; 30(5): 637–54

    Article  PubMed  Google Scholar 

  30. Bond GE. Lessons learned from the implementation of a web-based nursing intervention. Comput Inform Nurs 2006; 24(2): 66–74

    Article  PubMed  Google Scholar 

  31. Kaufman DR, Patel VL, Hilliman C, et al. Usability in the real world: assessing medical information technologies in patients’ homes. J Biomed Inform 2003; 36(1–2): 45–60

    Article  PubMed  Google Scholar 

  32. Casalino L, Gillies R, Shortell S, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA 2003; 289(4): 434–41

    Article  PubMed  Google Scholar 

  33. Schmittdiel JA, Shortell SM, Rundall TG, et al. Effect of primary health care orientation on chronic care management. Ann Fam Med 2006; 4(2): 117–23

    Article  PubMed  Google Scholar 

  34. Rundall TG, Shortell SM, Wang MC, et al. As good as it gets? Chronic care management in nine leading US physician organisations. BMJ 2002 Oct; 325(7370): 958–61

    Article  PubMed  Google Scholar 

  35. Atherton M. Outcome measures of efficacy associated with a web-enabled asthma self-management programme. Dis Manage Health Outcomes 2000; 8(4): 233–42

    Article  Google Scholar 

  36. McKay HG, King D, Eakin EG, et al. The diabetes network internet-based physical activity intervention: a randomized pilot study. Diabetes Care 2001; 24(8): 1328–34

    Article  PubMed  CAS  Google Scholar 

  37. Lieberman MA, Golant M, Giese-Davis J, et al. Electronic support groups for breast carcinoma: a clinical trial of effectiveness. Cancer 2003; 97: 920–5

    Article  PubMed  Google Scholar 

  38. Luce P, Phillips J, Benjamin R, et al. Technology for community alliances. J Ambul Care Manage 2004; 27(4): 366–74

    PubMed  Google Scholar 

  39. Larsen DL, Cannon W, Towner S. Longitudinal assessment of a diabetes care management system in an integrated health network. J Manag Care Pharm 2003; 9(6): 552–8

    PubMed  Google Scholar 

  40. Gomaa WH, Morrow T, Muntendam P. Technology-based disease management: a low-cost, high-value solution for the management of chronic disease. Dis Manage Health Outcomes 2001; 9(10): 577–88

    Article  Google Scholar 

  41. Welch J, Dowell S, Johnson CS. Feasibility of using a personal digital assistant to self-monitor diet and fluid intake: a pilot study. Nephrol Nurs J 2007; 34(1): 43–8

    PubMed  Google Scholar 

  42. Grant RW, Cagliero E, Chueh H, et al. Internet use among primary care patients with type 2 diabetes: the generation and education gap. J Gen Intern Med 2005; 20: 470–3

    Article  PubMed  Google Scholar 

  43. Millard RW, Fintak PA. Use of the internet by patients with chronic illness. Dis Manage Health Outcomes 2002; 10(3): 187–94

    Article  Google Scholar 

  44. Lieberman DA. Management of chronic pediatric diseases with interactive health games: theory and research findings. J Ambul Care Manage 2000; 24(1): 26–38

    Google Scholar 

  45. Leedy PD, Ormrod JE. Practical research: planning and design. 8th ed. Upper Saddle River (NJ): Pearson Education, Inc., 2005

    Google Scholar 

  46. Evangelista LS, Stromberg A, Westlake C, et al. Developing a web-based education and counseling program for heart failure patients. Prog Cardiovasc Nurs 2006; Fall: 196-201

  47. Dickerson SS, Boehnke M, Ogle C, et al. Seeking and managing hope: patients’ experiences using the internet for cancer care. Oncol Nurs Forum 2006; 33(1): E8–17

    Article  PubMed  Google Scholar 

  48. Fisher EB, Brownson CA, O’Toole ML, et al. Ecological approaches to self-management: the case of diabetes. Am J Public Health 2005 Sept; 95(9): 1523–35

    Article  PubMed  Google Scholar 

  49. Neuhauser D. The coming third health care revolution: personal empowerment. Qual Manag Health Care 2003; 12(3): 171–84

    PubMed  Google Scholar 

  50. Protocol Driven Healthcare, Inc. MyAsthma™ [online]. Available from http://www.myasthma.com/ [Accessed 2008 Aug 25]

  51. Nobel JJ, Norman GK. Emerging information management technologies and the future of disease management. Dis Manage 2003; 6(4): 219–31

    Article  Google Scholar 

  52. Robinson JC, Yegian JM. Medical management after managed care. Health Aff 2004; 23 Suppl. W4: 269–80

    Google Scholar 

  53. Villagra VG. Integrating disease management into the outpatient delivery system during and after managed care. Health Aff 2004; 23 Suppl. W4: 281–3

    Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael R. Solomon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Solomon, M.R. Information Technology to Support Self-Management in Chronic Care. Dis-Manage-Health-Outcomes 16, 391–401 (2008). https://doi.org/10.2165/0115677-200816060-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/0115677-200816060-00004

Keywords

Navigation