Learning Objective #1: Verbalize three benefits of a nurse case management program

Learning Objective #2: Discuss two barriers to caring for the patient with a chronic disease

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Diabetes is a prevalent and costly chronic disease. The average hemoglobin A1c (A1c) among diabetics is 9.2%, well above American Diabetes Association (ADA) goal of < 7.0%. Eliminating barriers to glycemic control remains as a significant challenge. The purpose was to investigate the effectiveness of a patient-centered hybrid case management intervention compared to usual diabetes care. One year randomized, controlled, longitudinal study. Primary measure was change in A1c. Secondary outcomes were compliance with ADA care process measures. Qualitative interviews with 19 participants were conducted after 12 months to assess perceptions of care. Results: 81 participants were enrolled (43 randomized to case management and 38 to usual care). Groups were statistically similar by age, gender, co-morbidities and initial A1c. A1c screening compliance (> 3 tests completed in study year to approximate quarterly screening) was significantly greater in the case management group (97.4% vs 37.1%, p < .001). The case management group's mean A1c improved from 10.27 to 7.95 (p < .001), but the A1c screening noncompliance in the usual care group prevented a statistical comparison of final A1c changes between the groups. There were clinically and statistically improved compliance measures in the case management group for pneumococcal vaccination (74.4% vs 44.1%, p < .008), influenza vaccination (69.2% vs 47.1%, p < .05), foot exams (71.8% vs 45.5%, p = .034), and microalbuminuria screening (89.5% vs 71.4%, p = .05). Themes regarding the impact of the case management from the patients' perspective were mastery of self-care, the nurse as coach, a sense of feeling better, and partnership with providers to facilitate self-care. Conclusion: A primary care-based nurse case management program following multidisciplinary assessment is effective in improving glycemic control and diabetes care process outcomes. This study supports the positive impact of nursing on participants' perceptions of care, well-being and engagement in self-management.