Minority Health Archive

The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial.

Gary, Tiffany L and Batts-Turner, Marian and Yeh, Hsin-Chieh and Hill-Briggs, Felicia and Bone, Lee R and Wang, Nae-Yuh and Levine, David M and Powe, Neil R and Saudek, Christopher D and Hill, Martha N and McGuire, Maura and Brancati, Frederick L (2009) The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Archives of internal medicine, 169 (19). pp. 1788-1794. ISSN 1538-3679

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Abstract

BACKGROUND: Although African American adults bear a disproportionate burden from diabetes mellitus (DM), few randomized controlled trials have tested culturally appropriate interventions to improve DM care. METHODS: We randomly assigned 542 African Americans with type 2 DM enrolled in an urban managed care organization to either an intensive or minimal intervention group. The intensive intervention group consisted of all components of the minimal intervention plus individualized, culturally tailored care provided by a nurse case manager (NCM) and a community health worker (CHW), using evidence-based clinical algorithms with feedback to primary care providers (eg, physicians, nurse practitioners, or physician assistants). The minimal intervention consisted of mailings and telephone calls every 6 months to remind participants about preventive screenings. Data on diabetic control were collected at baseline and at 24 months by blind observers; data emergency department (ER) visits and hospitalizations were assessed using administrative data. RESULTS: At baseline, participants had a mean age of 58 years, 73% were women, and 50% were living in poverty. At 24 months, compared with the minimal intervention group, those in the intensive intervention group were 23% less likely to have ER visits (rate difference [RD], -14.5; adjusted rate ratio [RR], 0.77; 95% confidence interval [CI], 0.59-1.00). In on-treatment analyses, the rate reduction was strongest for patients who received the most NCM and CHW visits (RD, -31.0; adjusted RR, 0.66; 95% CI, 0.43-1.00; rate reduction downward arrow 34%). CONCLUSION: These data suggest that a culturally tailored intervention conducted by an NCM/CHW team reduced ER visits in urban African Americans with type 2 DM. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00022750.


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Item Type: Article
Additional Information: This article is available at the publisher’s Web site. Access to the full text is subject to the publisher’s access restrictions.
Subjects: Health > Public Health > Chronic Illness & Diseases > Diabetes
Practice > interventions
Research
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Depositing User: Users 141 not found.
Date Deposited: 14 Jul 2011 16:10
Last Modified: 14 Jul 2011 16:10
Link to this item (URI): http://health-equity.pitt.edu/id/eprint/2738

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