Evaluation of a Nurse-Care Management System to Improve Outcomes in Patients With Complicated Diabetes

Evaluation of a Nurse-Care Management System to Improve Outcomes in Patients With Complicated Diabetes C. Barr Taylor , MD 1 , Nancy Houston Miller , RN, BSN 1 , Kelly R. Reilly , MSN, CDE 1 , George Greenwald , MD 2 , Darby Cunning , MA 1 , Allison Deeter , MA 1 and Liana Abascal , MA 1 1 Stanford University School of Medicine, Stanford, California 2 Kaiser Permanente Medical Center, Santa Clara, California Abstract OBJECTIVE —This study evaluated the efficacy of a nurse-care management system designed to improve outcomes in patients with complicated diabetes. RESEARCH DESIGN AND METHODS —In this randomized controlled trial that took place at Kaiser Permanente Medical Center in Santa Clara, CA, 169 patients with longstanding diabetes, one or more major medical comorbid conditions, and HbA lc >10% received a special intervention ( n = 84) or usual medical care ( n = 85) for 1 year. Patients met with a nurse-care manager to establish individual outcome goals, attended group sessions once a week for up to 4 weeks, and received telephone calls to manage medications and self-care activities. HbA lc , LDL, HDL, and total cholesterol, triglycerides, fasting glucose, systolic and diastolic blood pressure, BMI, and psychosocial factors were measured at baseline and 1 year later. Annualized physician visits were determined for the year before and during the study. RESULTS —At 1 year, the mean reductions in HbA lc , total cholesterol, and LDL cholesterol were significantly greater for the intervention group compared with the usual care group. Significantly more patients in the intervention group met the goals for HbA 1c (