Case management for patients with poorly controlled diabetes: a randomized trial

Krein, Sarah L.; Klamerus, Mandi L.; Vijan, Sandeep; Lee, Jan L.; Fitzgerald, James T.; Pawlow, Alan; Reeves, Pamela; Hayward, Rodney A.

doi:10.1016/j.amjmed.2003.11.028

Cited by 120 publications

(132 citation statements)

References 34 publications

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“…Unfortunately, most approaches used to improve diabetes outcome measures have been ineffective in practice. These include: 1) reminding patients about appointments (5,6); 2) providing feedback information on patients to their treating physicians (7)(8)(9)(10), even when treatment recommendations for the patient were included (11,12); 3) case management (when the case manager could not make treatment decisions) (13,14); 4) physician education (15,16); and 5) multifaceted quality improvement interventions in the practice setting (17,18).…”

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confidence: 99%

Effect of a Nurse-Directed Diabetes Disease Management Program on Urgent Care/Emergency Room Visits and Hospitalizations in a Minority Population

Davidson

Ansari²,

Karlan³

2007

Diabetes Care

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OBJECTIVE -To evaluate whether nurse-directed diabetes care reduced preventable diabetes-related urgent care/emergency room visits and hospitalizations in a minority population.RESEARCH DESIGN AND METHODS -Diabetic patients who receive care in a county public health clinic were randomly selected for a Diabetes Managed Care Program (DMCP) in which a specially trained nurse followed detailed treatment algorithms to provide diabetes care for 1 year. Preventable diabetes-related urgent care/emergency room visits and hospitalizations for these patients incurred during the intervention year and the year before enrollment were compared. Preventable diabetes-related causes were defined as metabolic (diabetic ketoacidosis, hyperglycemia, or hypoglycemia) or infection (cellulitis, foot ulcer, osteomyelitis, fungal infection, or urinary tract infection).RESULTS -Use of the urgent care/emergency room and hospitalizations during the intervention year and the year prior were available for 331 patients who completed the DMCP intervention. There were 94 total urgent care/emergency room visits and hospitalizations in the year before entering the DMCP and 46 during the DMCP year, a 51% reduction. Preventable diabetes-related episodes were far fewer. During the prior year, 14 patients made 15 urgent care/emergency room visits and 5 patients incurred 6 hospitalizations. During the DMCP year, four different patients made five emergency room/urgent care visits and one other patient was hospitalized. Preventable diabetes-related use was significantly (P Ͻ 0.001) lower during the intervention year compared with the prior year. Total charges for urgent care/emergency room visits and hospitalizations only (not other charges related to diabetes care) during the year before entering the DMCP were $129,176 compared with $24,630 during the DMCP year.CONCLUSIONS -When compared with usual care, nurse-directed diabetes care resulted in significantly fewer urgent care/emergency room visits and hospitalizations for preventable diabetes-related causes. Policy makers seeking to improve diabetes care and conserve resources should seriously consider adopting this approach. Diabetes Care 30:224 -227, 2007

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confidence: 99%

Effect of a Nurse-Directed Diabetes Disease Management Program on Urgent Care/Emergency Room Visits and Hospitalizations in a Minority Population

Davidson

Ansari²,

Karlan³

2007

Diabetes Care

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“…A recent well-designed evaluation of a disease management intervention for diabetics reported no improvements in glycemic control but accompanied this null result with key data, such as the low success rate for nurses trying to contact patients in the intervention group. 26 Not reporting such information, which is currently the norm in the literature, would be like conducting a drug trial in which it is not reported if the patients actually took the medication.…”

Section: Where To Go From Here?mentioning

confidence: 99%

Evidence-Based Quality Improvement: The State Of The Science

Shojania

Grimshaw²

2005

Health Affairs

608

391

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Routine practice fails to incorporate research evidence in a timely and reliable fashion. Many quality improvement (QI) efforts aim to close these gaps between clinical research and practice. However, in sharp contrast to the paradigm of evidence-based medicine, these efforts often proceed on the basis of intuition and anecdotal accounts of successful strategies for changing provider behavior or achieving organizational change. We review problems with current approaches to QI research and outline the steps required to make QI efforts based as much on evidence as the practices they seek to implement.

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“…iabetes case management (DCM) may improve medical outcomes (1,2). Case managers coordinate care and often provide a mix of interventions, e.g., telephone outreach, education, reminders.…”

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confidence: 99%

Psychosocial Outcomes of Telemedicine Case Management for Elderly Patients With Diabetes

et al. 2007

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Case management for patients with poorly controlled diabetes: a randomized trial

Cited by 120 publications

References 34 publications

Effect of a Nurse-Directed Diabetes Disease Management Program on Urgent Care/Emergency Room Visits and Hospitalizations in a Minority Population

Effect of a Nurse-Directed Diabetes Disease Management Program on Urgent Care/Emergency Room Visits and Hospitalizations in a Minority Population

Evidence-Based Quality Improvement: The State Of The Science

Psychosocial Outcomes of Telemedicine Case Management for Elderly Patients With Diabetes

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