Nurse case manager effectiveness and case load in a large clinical practice: implications for workforce development.
OBJECTIVE
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 HbA(1c), and diet instruction by a registered dietitian, the change in HbA(1c) remained significantly greater among those patients with a case manager than in those without (-0.52 units with vs. -0.17 units without, P < 0.006). The case load used to achieve this outcome averaged one nurse case manager per 365 patients.


CONCLUSIONS
In this setting, a case management team comprised of four nurses with varying degrees of clinical experience was effective in improving adherence with diabetes services and had a favourable effect on short-term glucose control trends.
Wilson
C
C
Division of Centers of Excellence, Phoenix Indian Medical Center, Phoenix, AZ 85016, USA.
Curtis
J
J
Lipke
S
S
Bochenski
C
C
Gilliland
S
S
D000328:Adult; D000368:Aged; D000413:Alaska; D001786:Blood Glucose / Q000378:metabolism; D019090:Case Management / Q000458:organization & administration*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000451:nursing* / Q000628:therapy; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D012189:Retrospective Studies
D001786:Blood Glucose