Project Title

A mobile health infrastructure to support underserved patients with chronic conditions

Shortened Title

Mobile health for chronic disease support

Publication Date



Introduction. Underserved populations report a high rate of cell phone use and an interest in utilizing mobile technology for health care. A mobile health infrastructure may provide an opportunity to transform health care delivery for underserved patients with multiple chronic conditions (MCC). This study assesses the feasibility of an automated bi-directional short message service (SMS) system to support patients with MCC.

Methods. In this quasi-experimental study, adult patients (n=135) with diabetes selected preferred content and scheduling for blood glucose, blood pressure, and step count text message prompts. Outreach messages were sent to patients overdue for laboratory tests and medications. Focus groups in English and Spanish were held to solicit participants’ perspectives. Data were exported from the SMS Patient Relationship Management (PRM) software platform and EMR for analysis using SAS software. Manual review of pharmacy and laboratory data used for outreach was conducted for quality assurance.

Results. Patients sent more than 6,000 correctly-formatted responses which were automatically transferred to the EMR. Participant response rates to the prompts were 53.7% for blood glucose prompts (3,633 responses), 48.8% for step count prompts (1,934 responses), and 31.9% for blood pressure prompts (222 responses). Laboratory data integration was achieved, but pharmacy data gaps required ongoing manual review. Focus group participants reported improved self-management behaviors and awareness of health information.

Conclusions. Use of a SMS-based infrastructure was feasible and may enhance health care system support of patients with MCC.

EHR/EMR System or Vendor


Healthcare Settings

Primary care or ambulatory clinics, Community health centers

Data Types

Electronic Health/Medical Records (EHR or EMR), Pharmacy databases, Patient Registries, Personal Health Records

Geographic scope type


Locations of Focus


Population Network Size

135 patients with diabetes and an SMS capable cell phone participated in a pilot study to test the functionality of the infrastructure

Informatics Platform/Tools

A software platform, the Patient Relationship Management (PRM), was created from a commercially available Customer Relationship Management platform

Major Partners

EMC Consulting assisted with the development of the PRM platform

CER/PCOR Study Priority Populations

Individuals who need chronic care, Diabetes mellitus (Diabetes)

Treatment Comparators

This project developed an infrastructure that enables text message-based chronic disease support and will serve as a platform for conducting future comparative effectiveness studies.

Outcome(s) of Interest

This AHRQ funded study enabled the development of the PRM platform for SMS-based chronic disease support and included integration with clinical data sets. Ongoing studies of the PRM platform will evaluate the impact of SMS outreach on: appointment attendance, weight loss, tobacco cessation, and vaccination rates.

Suggested Reading

Fischer HH, Moore SL, Ginosar D, Davidson AJ, Rice-Peterson CM, Durfee MJ, MacKenzie TD, Estacio, RO, Steele, AW. Care by cell phone: Text messaging for chronic disease management. American Journal of Managed Care. 2012; 18(2): e42-47.

Acknowledgement of Funders

This study was funded by the Agency for Healthcare Research and Quality grant number 1R24HS019453-01