The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial.
BACKGROUND
Although African American adults bear a disproportionate burden from diabetes mellitus (DM), few randomized controlled trials have tested culturally appropriate interventions to improve DM care.


METHODS
We randomly assigned 542 African Americans with type 2 DM enrolled in an urban managed care organization to either an intensive or minimal intervention group. The intensive intervention group consisted of all components of the minimal intervention plus individualized, culturally tailored care provided by a nurse case manager (NCM) and a community health worker (CHW), using evidence-based clinical algorithms with feedback to primary care providers (eg, physicians, nurse practitioners, or physician assistants). The minimal intervention consisted of mailings and telephone calls every 6 months to remind participants about preventive screenings. Data on diabetic control were collected at baseline and at 24 months by blind observers; data emergency department (ER) visits and hospitalizations were assessed using administrative data.


RESULTS
At baseline, participants had a mean age of 58 years, 73% were women, and 50% were living in poverty. At 24 months, compared with the minimal intervention group, those in the intensive intervention group were 23% less likely to have ER visits (rate difference [RD], -14.5; adjusted rate ratio [RR], 0.77; 95% confidence interval [CI], 0.59-1.00). In on-treatment analyses, the rate reduction was strongest for patients who received the most NCM and CHW visits (RD, -31.0; adjusted RR, 0.66; 95% CI, 0.43-1.00; rate reduction downward arrow 34%).


CONCLUSIONS
These data suggest that a culturally tailored intervention conducted by an NCM/CHW team reduced ER visits in urban African Americans with type 2 DM.


BACKGROUND
clinicaltrials.gov Identifier: NCT00022750.
Department of Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. tgary@jhsph.edu
Tiffany L
TL
Gary
Marian
M
Batts-Turner
Hsin-Chieh
HC
Yeh
Felicia
F
Hill-Briggs
Lee R
LR
Bone
Nae-Yuh
NY
Wang
David M
DM
Levine
Neil R
NR
Powe
Christopher D
CD
Saudek
Martha N
MN
Hill
Maura
M
McGuire
Frederick L
FL
Brancati
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015142:Baltimore / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism*; D019090:Case Management; D003153:Community Health Services; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D010348:Patient Care Team; D013689:Telephone; D014505:Urban Population / Q000706:statistics & numerical data*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human