title: Nurse care manager collaboration with community-based physicians providing diabetes care: a randomized controlled trial.
abstract: The purpose of this study was to demonstrate the potential value of close collaboration at the office level of a nurse care manager with community-based primary care physicians in the care of adult patients with type 2 diabetes, particularly those physicians not affiliated with an integrated care system that some managed care organizations provide.
  
  
  
  Patients with type 2 diabetes were recruited from the general population of a large metropolitan area. Each received a comprehensive evaluation of his or her diabetes with results reported to patients and their physicians (basic intervention). A random one-half of patients were additionally assigned to individual counseling, problem identification, care planning, and management recommendations by a nurse care manager (individualized intervention). The patients receiving only the basic intervention served as the control group to those receiving the individualized intervention. Re-evaluation of all patients at 6 months after their entry into the study determined the effectiveness of the nurse-directed individualized intervention using A1C, blood pressure, and cholesterol as outcome measures.
  
  
  
  Of 220 patients recruited, 197 had type 2 diabetes, randomly assigned only the basic intervention (102 patients) or individualized intervention (95 patients). Postintervention data were obtained on 164 patients (83%). Significant improvement occurred in mean systolic blood pressure and A1C of all patients in the individualized but not the basic intervention only group. Patients with a systolic blood pressure>or=130 mm Hg at baseline showed improvement if they had more than 2 contacts with the study nurse but not if they had less than 2 contacts.
  
  
  
  A nurse care manager collaborating at the office level with community-based primary care physicians can enhance the care provided to adult patients with type 2 diabetes. For those many physicians not affiliated with an integrated care system featured by some managed care organizations, this collaboration could underlie a team approach (nurse/patient/physician) for the ambulatory patient with diabetes that would be an essential element in a chronic disease model of care for diabetes at the community level.
authors.affiliation: The University of Michigan Medical School, Department of Medical Education, Ann Arbor, Michigan (Dr Hiss, Ms Armbruster, Ms Gillard)
authors.forename: Roland G
authors.initials: RG
authors.lastname: Hiss
authors.affiliation: The University of Michigan Medical School, Department of Medical Education, Ann Arbor, Michigan (Dr Hiss, Ms Armbruster, Ms Gillard)
authors.forename: Betty A
authors.initials: BA
authors.lastname: Armbruster
authors.affiliation: The University of Michigan Medical School, Department of Medical Education, Ann Arbor, Michigan (Dr Hiss, Ms Armbruster, Ms Gillard)
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Gillard
authors.affiliation: University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, Michigan (Dr. McClure's current address is Department of Biostatistics, University of Alabama at Birmingham.)
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D009718:Nurse Administrators; D010348:Patient Care Team; D018579:Patient Selection; D010821:Physicians, Family; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin