Diabetes management in a health maintenance organization - Efficacy of care management using cluster visits
Diabetes management in a health maintenance organization - Efficacy of care management using cluster visits
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DOI：
10.2337/diacare.22.12.2011
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发表时间：
1999-12-01
期刊：
影响因子：
16.2
通讯作者：
Javorski, WC
中科院分区：
文献类型：
--
作者：
Sadur, CN;Moline, N;Javorski, WC
目的：评估由糖尿病护理教育者领导的集群访问模式对控制不良的糖尿病成年患者提供门诊护理管理的有效性。研究设计和方法：本研究在Kaiser Permanente's Pleasanton， CA，中心的16-75岁的患者中进行随机对照试验，这些患者要么血糖控制不佳（HbA(1c) bb0 8.5%），要么在前一年没有进行HbA（1c）测试。干预对象接受多学科门诊糖尿病护理管理，由糖尿病护理教育者、心理学家、营养学家和药剂师提供，分组访问设置为10-18例患者/月，为期6个月。结果包括HbA（1c）水平的变化（从基线开始）；自我报告的自我保健实践、自我效能和满意度的变化；住院和门诊医疗保健的利用率。结果：干预后，干预组的HbA（1c）水平下降了1.3%，对照组下降了0.2% (P < 0.0001)，干预组的一些自我保健实践和一些自我效能测量显着改善。人们对这个项目的满意度很高。干预对象的住院利用率（P = 0.04）和门诊利用率（P < 0.01）均显著降低。结论：对成人糖尿病患者进行为期6个月的聚类访问组模型治疗后，血糖控制、自我效能和患者满意度得到改善，并导致医疗保健使用率降低。
OBJECTIVE - To evaluate the effectiveness of a cluster visit model led by a diabetes nurse educator for delivering outpatient care management to adult patients with poorly controlled diabetes.RESEARCH DESIGN AND METHODS - This study involved a randomized controlled trial among patients of Kaiser Permanente's Pleasanton, CA, center who were aged 16-75 years and had either poor glycemic control (HbA(1c) >8.5%) or no HbA(1c) test performed during the previous year. intervention subjects received multidisciplinary outpatient diabetes care management delivered by a diabetes nurse educator, a psychologist, a nutritionist, and a pharmacist in cluster visit settings of 10-18 patients/month for 6 months. Outcomes included change (from baseline) in HbA(1c) levels; self-reported changes in self-care practices, self-efficacy, and satisfaction; and utilization of inpatient and outpatient health care.RESULTS - After the intervention, HbA(1c) levels declined by 1.3% in the intervention subjects versus 0.2% in the control subjects (P < 0.0001), Several self-care practices and several measures of self-efficacy improved significantly in the intervention group. Satisfaction with the program was high. Both hospital (P = 0.04) and outpatient (P < 0.01) utilization were significantly lower for intervention subjects after the program.CONCLUSIONS - A 6-month cluster visit group model of care for adults with diabetes improved glycemic control, self-efficacy and patient satisfaction and resulted in a reduction in health care utilization after the program.