Language-concordant automated telephone self-management (ATSM, SMARTSteps)

Purpose #

To assess patient-reported medication adherence and deliver self-management support to a linguistically diverse, low-income population with diabetes — in each patient's own language — outside of usual clinic visits. Deployed as the SMARTSteps program for San Francisco Health Plan (a Medicaid/managed-care safety-net plan).

"the ATSM system provided 8–12 min weekly calls for 27 weeks in English, Cantonese, or Spanish." (Ratanawongsa, 2018, p. 3)

Mechanism #

Automated weekly touchtone telephone calls deliver rotating queries (medication adherence, self-care, psychosocial issues, access to preventive services). Patients type numeric responses (e.g., "In the last 7 days, how many days did you MISS taking your …"). "Out-of-range" responses trigger callbacks within three days from language-concordant lay health coaches who do collaborative goal-setting; a registered-nurse care manager supervises and routes actionable concerns to primary care.

"'Out-of-range' responses triggered callbacks within 3 days from a language-concordant lay health coaches, who engaged in collaborative goal-setting to form patient-centered action plans." (Ratanawongsa, 2018, p. 3)

Example(s) of usage #

SMARTSteps (Pasos Positivos), a quasi-experimental self-management intervention for San Francisco Health Plan members with diabetes (April 2009–March 2011), tailored for literacy, language, and culture with extensive patient input.

Other Notes #

ATSM is a health-information-technology (HIT) strategy highlighted by the Institute of Medicine for engaging chronic-disease patients with limited health literacy outside usual care. (Note: the plugin's relation grammar does not yet define EVD/CLM→ART edges, so links to this artifact are wikilinks for now.)