Connected health: a new framework for evaluation of communication technology use in care improvement strategies for type 2 diabetes.

Current methods of analyzing the use of communication technologies in diabetes care improvement programs are limited by a poor understanding of the impact of technology on the delivery of care. We applied a standardized methodology using a functional framework to analyze 14 diabetes care improvement programs that used communications technology. Controlled trials and observational studies were selected after searching 5 electronic databases to identify care improvement programs for type 2 diabetes that used communications technology in the past 10 years with greater than 10 subjects. A 3-stage framework was used to analyze intervention elements: 1) functional components, 2) structural components, and 3) level of automation in program design. Using this methodology we found marked variability in operational design of programs and poor rationalization of choice of outcome metrics with program components. Although 11 of 14 studies showed significant declines in HbA1c, our analysis indicated that the causal pathways remain unclear. Recent systematic reviews have highlighted the difficulties in evaluating communication technology use in diabetes. The functional framework presented in this review provides a systems approach to the problem and represents a standardized methodology for analyzing communications technology use in diabetes care.