A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes

Tiffany L Gary , Marian Batts-Turner , Lee R Bone , Hsin-chieh Yeh , Nae-Yuh Wang , Felicia Hill-Briggs , David M Levine , Neil R Powe , Martha N Hill , Christopher Saudek , Maura McGuire , Frederick L Brancati
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引用次数: 82

Abstract

The objective of the study was to determine the effectiveness and cost-effectiveness of primary care and community-oriented interventions in managing HbA1c, blood pressure, and lipids, and reducing hospitalizations and emergency room visits over 2 years. We describe an ongoing, randomized controlled trial of 542 urban African-Americans with type 2 diabetes ages 25 years and older who are members of a university-affiliated managed-care organization in Baltimore, MD. The participants are 74% female, have a mean age of 58 years, and 35% have yearly incomes greater than US$7500. Participants were randomized to one of two intervention groups for a period of 2 years: (1) usual medical care plus minimal telephone intervention implemented by a trained lay health educator (control group) or (2) usual medical care plus intensive intervention implemented by a nurse case manager (NCM)/community health worker (CHW) team. The intensive NCM/CHW team executes individual plans of care using evidence-based algorithms that focus on traditional diabetes self-management, screening and management of diabetes-related complications, and social issues surrounding diabetes care. Face-to-face NCM visits are conducted in the clinic once per year and CHW visits are conducted in the participant's home one to three times per year, both with additional follow-up contacts as needed. Written and verbal feedback (when necessary) is provided to the participant's primary care physician. All participants are expected to attend a 24-month follow-up visit where data are collected by interviewers blinded to intervention assignment. As of May 1, 2003, recruitment is complete, interventions are being fully implemented, and 24-month follow-up visits are beginning. Baseline sociodemographic characteristics, health-care utilization, health behaviors, and clinical characteristics of the study population are reported. This study is designed to test the hypothesis that a primary-care-based NCM plus CHW team approach is an effective, practical, and economically feasible strategy for translating current knowledge about type 2 diabetes into high-quality health care for urban African-Americans.

一项随机对照试验,观察护士、病例管理人员和社区卫生工作者团队干预城市非洲裔2型糖尿病患者的效果
该研究的目的是确定初级保健和社区为导向的干预措施在管理HbA1c、血压和血脂方面的有效性和成本效益,并减少住院和急诊室就诊2年以上。我们描述了一项正在进行的随机对照试验,542名25岁及以上的城市非裔美国人2型糖尿病患者,他们是马里兰州巴尔的摩市一所大学附属管理医疗组织的成员。参与者中74%为女性,平均年龄为58岁,35%年收入超过7500美元。参与者被随机分为两个干预组,为期2年:(1)常规医疗护理加由训练有素的非专业健康教育者实施的最低程度的电话干预(对照组)或(2)常规医疗护理加由病例管理护士(NCM)/社区卫生工作者(CHW)团队实施的强化干预。密集的NCM/CHW团队使用循证算法执行个人护理计划,重点关注传统的糖尿病自我管理、糖尿病相关并发症的筛查和管理以及糖尿病护理的社会问题。每年在诊所进行一次面对面的NCM访问,每年在参与者家中进行一到三次CHW访问,根据需要都有额外的随访联系。书面和口头反馈(必要时)提供给参与者的初级保健医生。所有参与者预计将参加为期24个月的随访,其中数据由对干预分配不知情的采访者收集。截至2003年5月1日,招募工作已完成,干预措施正在全面实施,并开始进行为期24个月的随访。报告了研究人群的基线社会人口学特征、卫生保健利用、健康行为和临床特征。本研究旨在验证一种假设,即基于初级保健的NCM加CHW团队方法是一种有效、实用且经济可行的策略,可将当前关于2型糖尿病的知识转化为城市非洲裔美国人的高质量医疗保健。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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