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.

Full 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.

Author information

Author/s: Gary, Tiffany L (TL); Batts-Turner, Marian (M); Yeh, Hsin-Chieh (HC); Hill-Briggs, Felicia (F); Bone, Lee R (LR); Wang, Nae-Yuh (NY); Levine, David M (DM); Powe, Neil R (NR); Saudek, Christopher D (CD); Hill, Martha N (MN); McGuire, Maura (M); Brancati, Frederick L (FL);

Affiliation: Department of Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. tgary(-atsign-)jhsph.edu

Grants: K01-HL084700 (Agency:NHLBI NIH HHS) ; K24-DK6222 (Agency:NIDDK NIH HHS) ; R00052 (Agency:PHS HHS) ; R01-DK48117 (Agency:NIDDK NIH HHS) ; U01-DK57149-05S1 (Agency:NIDDK NIH HHS)

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2009-Oct; vol 169 (issue 19) : pp 1788-94

Dates: Created 2009/10/27; Completed 2009/11/05;

PMID: 19858437, status: MEDLINE (last retrieval date: 11/5/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Arch Intern Med. 2009 Oct 26;169(19):1804-5. (PMID: 19858439)

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