Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study

Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients' first and last hemoglobin A (HbA ) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Among all 95 patients, the average HbA decreased by -1.0 (from 8.2% to 7.2%; P8%, the average HbA decreased by -2.1 (from 10.2% to 8.1%; P9%, the average HbA decreased by -2.8 (from 11% to 8.2%; P