Impact of nurse case management on diabetes co-morbidity

护士病例管理对糖尿病合并症的影响

• 批准号: 7121979
• 负责人: ROBERT A GABBAY
• 金额: $ 58.58万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-15 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7121979
• 关键词: behavior modification; behavioral /social science research tag; clinical research; clinical trials; comorbidity; depression; diabetes education; diabetes mellitus therapy; disease /disorder prevention /control; focus groups; health care policy; health service demonstration project; human subject; human therapy evaluation; hyperlipidemia; hypertension; interview; longitudinal human study; noninsulin dependent diabetes mellitus; nurse patient relations; nurse performance; outcomes research; patient care management; quality of life; self care; therapy compliance

DESCRIPTION (provided by applicant): Despite strong evidence that achieving recommended HbA1c, LDL cholesterol and blood pressure (BP) goals can substantially reduce morbidity, mortality, and costs in patients with diabetes, the majority of patients do not achieve these targets. The broad goal of our research program is to successfully translate empirical knowledge regarding diabetes treatment and management into sustainable and effective clinical practice. Current barriers include lack of physician contact time, insufficient education on self-management skills, inadequate strategies to foster behavior change and patient adherence, and the difficulty of translating evidence-based clinical guidelines into practice. Nurse case management (NCM) may offer the opportunity for better outcomes at lower cost. Previous studies have targeted a single clinical parameter (glycemic control) and have not, for the most part, addressed the well-known co-morbidities associated with diabetes such as hypertension, hyperlipidemia, and depression. We propose a three-year, randomized clinical trial examining the impact of enhanced nurse case management added to usual primary care given to high-risk patients with diabetes (HbA1c > 8.5, LDL cholesterol >130, or BP >140/90) and will include a significant minority population. Nurse case mangers will meet at regular clinic visits with the experimental group and engage in a more structured approach to improving patient self-management and behavior change through the use of motivational interviewing techniques. The NCM intervention will also include the provision of basic diabetes self-management education, tracking of patient outcomes, and implementation of standing orders for process . measures. Clinical guidelines will be used to prompt physician action and nurses will provide individualized patient follow-up . Our study is unique in addressing several shortcomings in the NCM literature- cost effectiveness, durability of effect, impact on quality of life and adherence of patients ; and satisfaction of both patients and providers. A structured training program will be used and specifics of the intervention will be well documented. Finally, we will examine the barriers encountered and means for overcoming them, as well as the organizational elements that are necessary to successfully implement this multiple risk factor intervention in high-risk populations.

描述（由申请人提供）： 尽管有强有力的证据表明，达到推荐的HbA 1c、LDL胆固醇和血压（BP）目标可以大幅降低糖尿病患者的发病率、死亡率和成本，但大多数患者没有达到这些目标。我们的研究计划的广泛目标是成功地将有关糖尿病治疗和管理的经验知识转化为可持续和有效的临床实践。目前的障碍包括缺乏医生的接触时间，自我管理技能的教育不足，不充分的战略，以促进行为改变和患者的依从性，以及难以将循证临床指南转化为实践。护士个案管理（NCM）可以提供以较低成本获得更好结果的机会。先前的研究针对单一临床参数（血糖控制），并且在大多数情况下没有解决与糖尿病相关的众所周知的合并症，如高血压、高脂血症和抑郁症。 我们提出了一项为期三年的随机临床试验，研究在常规初级护理的基础上加强护士病例管理对糖尿病高危患者（HbA 1c> 8.5，LDL胆固醇>130，或BP >140/90）的影响，并将包括一个重要的少数群体。护士个案管理人员将定期与实验组进行门诊访问，并通过使用激励性访谈技术，采用更有条理的方法来改善患者的自我管理和行为改变。NCM干预还将包括提供基本的糖尿病自我管理教育，跟踪患者结局，以及执行常规流程。措施临床指南将用于提示医生采取行动，护士将提供个性化的患者随访。我们的研究在解决NCM文献中的几个缺点方面是独一无二的-成本效益，效果的持久性，对患者生活质量和依从性的影响;以及患者和提供者的满意度。将使用结构化的培训计划，并将详细记录干预措施。最后，我们将研究遇到的障碍和克服这些障碍的方法，以及在高危人群中成功实施这种多风险因素干预所必需的组织要素。