Nurse case manager effectiveness and case load in a large clinical practice: implications for workforce development

Aims Description of nurse case management experiences across different settings and patient populations is needed to define critical elements of the intervention and to help develop a workforce capable of responding to the growing diabetic population. Methods In a clinic providing services to American Indian and Alaska Native people, a retrospective cohort design was used to assess outcomes of patients who did and did not receive case management services and to quantify the case load of a team of four nurse case managers. Results Patients with nurse case managers were more likely to have an eye examination [OR 2.9, 95% CI (2.1, 3.8)], diet and exercise instruction by a registered dietitian [OR 2.8, 95% CI (1.9, 4.1)], self monitor blood glucose [OR 2.1, 95% CI (1.5, 3.1)], dental examination [OR 1.7, 95% CI (1.3, 2.3)], foot examination [OR 1.6, 95% CI (1.2, 2.1)], and nephropathy screening [OR 1.6, 95% CI (1.2, 2.1)]. After adjustment for type of treatment, initial HbA1c, and diet instruction by a registered dietitian, the change in HbA1c remained significantly greater among those patients with a case manager than in those without (−0.52 units with vs. −0.17 units without, P