Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization - A randomized, controlled trial
Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization - A randomized, controlled trial
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DOI：
10.7326/0003-4819-129-8-199810150-00004
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发表时间：
1998-10-15
影响因子：
39.2
通讯作者：
Koplan, JP
中科院分区：
文献类型：
--
作者：
Aubert, RE;Herman, WH;Koplan, JP
背景：控制高血糖可以延缓或预防糖尿病并发症，但许多糖尿病患者并未达到最佳控制。目的：比较接受护士病例管理的患者和接受常规护理的患者的糖尿病控制情况。设计：随机对照试验。设置：团体模式健康维护组织 (HMO) 的初级保健诊所。患者：17 名 1 型糖尿病患者和 121 名 2 型糖尿病患者。干预：护士病例经理遵循书面记录在家庭医生和内分泌科医生的指导下制定管理算法，将治疗的变化传达给初级保健医生。所有患者均通过其初级保健医生接受持续护理。 测量：在基线和 12 个月时测量主要结果，即血红蛋白 A(1c) (HbA(1c)) 值。还评估了空腹血糖水平、药物类型和剂量、体重、血压、血脂水平、患者自知的健康状况、严重低血糖的发作以及急诊科和住院情况。结果：72%的患者完成了随访。护士病例管理组患者的 HbA(1c) 值平均下降 1.7 个百分点，空腹血糖水平平均下降 43 mg/dL (2.38 mmol/L)；常规护理组患者的 HbA(1c) 值下降了 0.6 个百分点，空腹血糖水平下降了 15 mg/dL (0.83 mmol/L) (P < 0.01)。护士病例管理组自我报告的健康状况有所改善（P = 0.02）。护士病例管理干预与药物类型或剂量、体重、血压或血脂的统计学显着变化或不良事件无关。结论：具有相当大管理责任的护士病例管理人员可以与初级保健医生和内分泌科医生合作，帮助改善团体模型 HMO 中糖尿病患者的血糖控制。
Background: Control of hyperglycemia delays or prevents complications of diabetes, but many persons with diabetes do not achieve optimal control.Objective: To compare diabetes control in patients receiving nurse case management and patients receiving usual care.Design: Randomized, controlled trial.Setting: Primary care clinics in a group-model health maintenance organization (HMO).Patients: 17 patients with type 1 diabetes mellitus and 121 patients with type 2 diabetes mellitus.Intervention: The nurse case manager followed written management algorithms under the direction of a family physician and an endocrinologist, Changes in therapy were communicated to primary care physicians. All patients received ongoing ca re through their primary care physicians.Measurements: The primary outcome, hemoglobin A(1c) (HbA(1c)) value, was measured at baseline and at 12 months. Fasting blood glucose levels, medication type and dose, body weight, blood pressure, lipid levels, patient-perceived health status, episodes of severe hypoglycemia, and emergency department and hospital admissions were also assessed.Results: 72% of patients completed follow-up. Patients in the nurse case management group had mean decreases of 1.7 percentage points in HbA(1c) values and 43 mg/dL (2.38 mmol/L) in fasting glucose levels; patients in the usual care group had decreases of 0.6 percentage points in HbA(1c) values and 15 mg/dL (0.83 mmol/L) in fasting glucose levels (P < 0.01). Self-reported health status improved in the nurse case management group (P = 0.02). The nurse case management intervention was not associated with statistically significant changes in medication type or dose, body weight, blood pressure, or lipids or with adverse events.Conclusions: A nurse case manager with considerable management responsibility can, in association with primary care physicians and an endocrinologist, help improve glycemic control in diabetic patients in a group-model HMO.