2.50
Hdl Handle:
http://hdl.handle.net/10755/158194
Type:
Presentation
Title:
Diabetes Case Management: Effects of Glycemic Control
Abstract:
Diabetes Case Management: Effects of Glycemic Control
Conference Sponsor:Western Institute of Nursing
Conference Year:2005
Author:Kelley, Patricia Ann, DNSc, RN, FNP, GNP, FAANP
P.I. Institution Name:TriService Nursing Research c/o Tri Service Nursing Research Program
Title:Executive Director
Background: Diabetes is one of the most prevalent and costly chronic diseases in the U.S. The average HbA1c among diabetics is 9.2%, well above American Diabetes Association (ADA) goal of < 7.0%. Eliminating barriers to glycemic control among individuals living with diabetes and their primary care providers remains a significant challenge. The purpose of this study was to investigate the effectiveness of a patient-centered hybrid case management intervention compared to usual diabetes care in a large military academic hospital. Methods: A one year randomized, controlled, longitudinal study. The hybrid case management program consisted of a diabetes clinical assessment using multiple providers with subsequent nurse case management. The initial multidisciplinary visit was followed by ongoing contact either in person or via telephone on a regular basis with the nurse case manager who coordinated care with the patient's usual primary care physician. The program targeted the higher risk diabetic patients with HbA1c > 8%. The primary outcomes for the study were change in HbA1c at 12 months and compliance with ADA recommended diabetes care process measures during this time, including quarterly HbA1c measurement when above target value, pneumococcal and influenza vaccination, microalbuminuria screening, and monofilament foot exams. Qualitative interviews with 19 participants were conducted after 12 months to assess perceptions of care. The constant comparative method of analysis was used to review interviews. Results: 81 participants were enrolled, with 43 randomized to case management and 38 to usual care. The groups are statistically similar by age, gender, co-morbidities and initial HbA1c. Four participants in the case management group and three in usual care withdrew early in the course of the study- 39/43 case-managed and 35/38 usual care participants have completed 12 months since randomization. HbA1c screening compliance (> 3 tests completed in study year to approximate quarterly screening) was significantly greater in the case management group (97.4% vs 37.1%, p < .001). The case management group's mean HbA1c improved from 10.27 to 7.95 (p < .001), but the HbA1c screening noncompliance in the usual care group prevented a statistical comparison of final HbA1c changes between the groups. There were also clinically and statistically improved compliance measures in the case management group for pneumococcal vaccination (74.4% vs 44.1%, p < .008), influenza vaccination (69.2% vs. 47.1%, p < .05), monofilament foot exams (71.8% vs 45.5%, p = .034), and microalbuminuria screening (89.5% vs. 71.4%, p = .05). Ten participants from each group underwent the qualitative interview. The most common themes regarding the positive impact of the case management program from the patient perspective that emerged were 1) a greater sense of mastery of self-care, 2) the importance of having a nurse function like a coach, 3) a personal sense of feeling better, and 4) the importance of a partnership with providers to facilitate self-care. Conclusion: In a large academic military hospital, a primary care-based nurse case management program following multidisciplinary assessment is effective in improving glycemic control and diabetes care process outcomes. This study extends earlier work by demonstrating the positive impact on participants' perceptions of care, well-being and engagement in the self-management of their chronic disease.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDiabetes Case Management: Effects of Glycemic Controlen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158194-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Diabetes Case Management: Effects of Glycemic Control</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2005</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Kelley, Patricia Ann, DNSc, RN, FNP, GNP, FAANP</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">TriService Nursing Research c/o Tri Service Nursing Research Program</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Executive Director</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">pakelley@usuhs.mil</td></tr><tr><td colspan="2" class="item-abstract">Background: Diabetes is one of the most prevalent and costly chronic diseases in the U.S. The average HbA1c among diabetics is 9.2%, well above American Diabetes Association (ADA) goal of &lt; 7.0%. Eliminating barriers to glycemic control among individuals living with diabetes and their primary care providers remains a significant challenge. The purpose of this study was to investigate the effectiveness of a patient-centered hybrid case management intervention compared to usual diabetes care in a large military academic hospital. Methods: A one year randomized, controlled, longitudinal study. The hybrid case management program consisted of a diabetes clinical assessment using multiple providers with subsequent nurse case management. The initial multidisciplinary visit was followed by ongoing contact either in person or via telephone on a regular basis with the nurse case manager who coordinated care with the patient's usual primary care physician. The program targeted the higher risk diabetic patients with HbA1c &gt; 8%. The primary outcomes for the study were change in HbA1c at 12 months and compliance with ADA recommended diabetes care process measures during this time, including quarterly HbA1c measurement when above target value, pneumococcal and influenza vaccination, microalbuminuria screening, and monofilament foot exams. Qualitative interviews with 19 participants were conducted after 12 months to assess perceptions of care. The constant comparative method of analysis was used to review interviews. Results: 81 participants were enrolled, with 43 randomized to case management and 38 to usual care. The groups are statistically similar by age, gender, co-morbidities and initial HbA1c. Four participants in the case management group and three in usual care withdrew early in the course of the study- 39/43 case-managed and 35/38 usual care participants have completed 12 months since randomization. HbA1c screening compliance (&gt; 3 tests completed in study year to approximate quarterly screening) was significantly greater in the case management group (97.4% vs 37.1%, p &lt; .001). The case management group's mean HbA1c improved from 10.27 to 7.95 (p &lt; .001), but the HbA1c screening noncompliance in the usual care group prevented a statistical comparison of final HbA1c changes between the groups. There were also clinically and statistically improved compliance measures in the case management group for pneumococcal vaccination (74.4% vs 44.1%, p &lt; .008), influenza vaccination (69.2% vs. 47.1%, p &lt; .05), monofilament foot exams (71.8% vs 45.5%, p = .034), and microalbuminuria screening (89.5% vs. 71.4%, p = .05). Ten participants from each group underwent the qualitative interview. The most common themes regarding the positive impact of the case management program from the patient perspective that emerged were 1) a greater sense of mastery of self-care, 2) the importance of having a nurse function like a coach, 3) a personal sense of feeling better, and 4) the importance of a partnership with providers to facilitate self-care. Conclusion: In a large academic military hospital, a primary care-based nurse case management program following multidisciplinary assessment is effective in improving glycemic control and diabetes care process outcomes. This study extends earlier work by demonstrating the positive impact on participants' perceptions of care, well-being and engagement in the self-management of their chronic disease.</td></tr></table>en_GB
dc.date.available2011-10-26T20:36:12Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:36:12Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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