The Case for “Outsourcing” Diabetes Care

Davidson, Mayer B.

doi:10.2337/diacare.26.5.1608

Cited by 16 publications

(17 citation statements)

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“…CONCLUSIONS -The evidencebased ADA guidelines are not being met. In the early 1990s, the average HbA 1c level was 9.5% (45), which improved to only 8.6% more recently (46). Onequarter to one-third of diabetic patients still have HbA 1c levels Ͼ9.5% (45).…”

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confidence: 99%

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Effect of Nurse-Directed Diabetes Care in a Minority Population

Davidson

2003

Diabetes Care

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OBJECTIVE -To determine whether diabetes care directed by nurses following detailed protocols and algorithms and supervised by a diabetologist results in meeting the evidence-based American Diabetes Association (ADA) process and outcome measures more often than care directed under usual care in a minority population. RESEARCH DESIGN AND METHODS -Studies were mainly conducted in two LosAngeles County clinics. In clinic A, nurse-directed diabetes care was provided to 252 patients (92% Hispanic and 2% African-American) referred by their primary care providers. These patients were hierarchically matched with 252 diabetic patients in clinic B (79% Hispanic and 19% African American). When nurse-directed care was abruptly discontinued in clinic A for administrative reasons, it was reestablished in clinic B. Those patients were randomly selected from a teaching clinic, and the outcomes in 114 patients who completed 1 year were compared with outcomes derived the year before receiving nurses' care. The following process and outcome measures were assessed in the study: 1) number of visits, 2) diabetes education, 3) nutritional counseling, 4) HbA 1c , 5) lipid profiles, 6) eye exams, 7) foot exams, 8) renal evaluations, and 9) ACE inhibitor therapy in appropriate patients.RESULTS -For patients under nurse-directed diabetes care in both clinics A and B, almost all process measures were carried out significantly more frequently than for the appropriate control patients. Under the care of nurses in clinic A, HbA 1c levels fell 3.5% from 13.3 to 9.8% in the 120 patients who were followed for at least 6 months, as compared with a 1.5% fall from 12.3 to 10.8% under usual (physician-directed) care in clinic B. During the year before enrolling in nurse-directed care in clinic B, mean HbA 1c levels decreased from 10.0 to 8.5%. At the end of a year under the nurses' care, the values fell further to 7.1%. The median value fell from 8.3 to 6.6%.CONCLUSIONS -Specially trained nurses who follow detailed protocols and algorithms under the supervision of a diabetologist can markedly improve diabetes outcomes in a minority population. This approach could help blunt the increased morbidity and mortality noted in minority populations. Diabetes Care 26:2281-2287, 2003D iabetes has a profound effect on the health of our population and the well-being of our economy. Diabetic retinopathy is the leading cause of blindness in people between 20 and 74 years of age (1). Diabetic nephropathy is the leading cause of patients undergoing dialysis for end-stage renal disease (ESRD) (2). Diabetic peripheral neuropathy is the underlying cause of nontraumatic lower-extremity amputations in diabetic patients (3). More than half of lower-extremity amputations occur in people with diabetes (4), even though only 5.1% of the population Ն20 years of age have been diagnosed with diabetes (5). The prevalence of coronary artery disease is twofold higher in men with diabetes and fourfold higher in women with diabetes compared with appropriate nondiabetic control subje...

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“…Only 3% of patients met the combined ADA outcome measures for glycemia, lipids, and blood pressure at urban academic centers (47). ADA process measures are usually met in Ͻ50% of diabetic patients (46).…”

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Effect of Nurse-Directed Diabetes Care in a Minority Population

Davidson

2003

Diabetes Care

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“…Specially trained nurses who follow sets of fixed rules and guidelines under the supervision of a diabetologist can markedly improve diabetes outcomes in minority populations. There can be almost 100% compliance with the ADArecommended process measures with outcome measures that are also close to the ADA guidelines (6)(7)(8)(9)(10)(11).…”

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confidence: 69%

A nurse-managed diabetes care programme

Pishdad

2007

International Journal of Clinical Practice

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“…Other studies related to chronic care and health coaching show that patient participation, proper training of the clinician, as well as collaborative efforts with the patient and clinician in goal setting are all key to improving the impact of a health coach on health and cost saving outcomes (Linden et al 2010;Hayes et al 2008). Davidson (2003) demonstrated that nursedirected care of diabetes patients has a positive impact on health outcomes. He stressed five specific challenges to outsourcing diabetes care, including (1) not enough nurses to handle the case loads, (2) geographical dispersal of physician practices and patient, (3) system of reimbursement, (4) potential psychological impediment on behalf of physicians in handing over care to nurses, and (5) financial barriers.…”

Section: Case Of a Diabetes Patient At Primary Care Practicementioning

confidence: 99%

Introducing the Health Coach at a Primary Care Practice: Impact on Quality and Cost (Part 1)

et al. 2011

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The cost of healthcare in U.S. is a poor value proposition. One of the primary goals of the healthcare reform act is to reduce cost while improving healthcare quality. We believe that adding a health coach will help in achieving this goal. The health coach is a medical professional who supports both the physician and the patient by meeting previously established goals. This research presents and analyzes the key roles of a health coach in a primary care practice.

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The Case for “Outsourcing” Diabetes Care

Cited by 16 publications

References 65 publications

Effect of Nurse-Directed Diabetes Care in a Minority Population

Effect of Nurse-Directed Diabetes Care in a Minority Population

A nurse-managed diabetes care programme

Introducing the Health Coach at a Primary Care Practice: Impact on Quality and Cost (Part 1)

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