Before the pandemic, Oluyemisi Ariyibi, MD, MPH, would sometimes wait months before learning whether patients with diabetes had followed her advice on how to better control their glucose levels.
The standard practice is to see patients once every three months. This meant that, despite her best efforts, it often wasn’t until the following visit that Dr. Ariyibi discovered that a patient hadn’t been able to get a prescribed medication or had struggled with care instructions.
That was, until the pandemic opened the door to telemedicine.
“Because of all the investments in telehealth that came with the pandemic, we had the tele-visit option now open to us,” said Dr. Ariyibi, an internal medicine specialist at SBH Health System in the Bronx. “My thought was...instead of wondering what they were doing in the three months since they last saw me—and just cursing the darkness—why don’t I light this little candle and say, ‘Hey, all I need is 15 minutes every two weeks.’”
A fellow with United Hospital Fund and Greater New York Hospital Association’s Clinical Quality Fellowship Program, Dr. Ariyibi created a bi-weekly telemonitoring program for a group of patients with diabetes and uncontrolled glucose levels. Studies have shown that using telemedicine to regularly monitor patients’ diabetes management can significantly improve their glycemic control.
Instead of being seen only every few months, the eventual 20 patients enrolled in Dr. Ariyibi’s program attended bi-weekly virtual check-ins to go over blood sugar logs, set glucose control targets, discuss treatment options, and identify barriers to treatment.
It didn’t take long to notice the impact, Dr. Ariyibi said. Within months, patients were not only better at recognizing how certain behaviors affected their glucose levels, but better understood how Dr. Ariyibi was their trusted teammate in tackling the disease.
“The patient was the master of this ship, but I became an ally—you could really see the wheels starting to turn in their heads,” Dr. Ariyibi said. “They became empowered.”
Ultimately, every patient who completed the telehealth program saw an improvement in their three-month blood sugar average, known as A1C. Of those, 40 percent had their uncontrolled glucose levels fall within the control range (an A1C of 7.5 or less), according to a check-in one year after the project’s start.
These results were particularly significant given SBH Health’s location in the Bronx, where 16 percent of the population lives with diabetes, the highest prevalence of any county in New York. Diabetes is the seventh leading cause of death in the U.S.
Given changes to telehealth reimbursement rates post-pandemic and the hospital’s transition to a new electronic medical records system, Dr. Ariyibi hasn’t been able to continue the bi-weekly monitoring since the CQFP project. Nevertheless, she says its value shouldn’t be understated.
Though in different ways, clinicians at SBH have continued more closely monitoring their patients with uncontrolled diabetes given the proven success of doing so, Dr. Ariyibi said.
Furthermore, communication gaps revealed by the telehealth project have led Dr. Ariyibi to plan a new initiative to improve care for diabetes patients.
“The study, as small as it was, was a great proof of concept,” Dr. Ariyibi said. “It exposed the holes and the feedback loops that were so vital to getting these patients controlled.”
Dr. Ariyibi’s initiative, called The PINCH Project—an acronym for pharmacists, IT, nursing, clinicians, and health educators—will work to close feedback loops among the different departments involved in diabetes care. It will include better identifying patients with uncontrolled A1C through electronic health records, increasing communication with pharmacists to fix prescription issues, and training nurses and health navigators in patient coaching.
The CQFP project has also affected Dr. Ariyibi’s personal career, she says.
Since participating in the fellowship, she has joined a judging panel for judging quality improvement projects at SBH Health System. She largely attributes both the success of her project and her confidence to join the panel to the supportive environment offered in the Clinical Quality Fellowship Program.
“CQFP gave me a voice,” Dr. Ariyibi said. “It showed me I had a point of view that was important, and I should let myself be heard. When I have something to say, I have ears that are ready to listen to me.”