title: Exploring the cost and clinical outcomes of integrating the registered nurse-certified diabetes educator into the patient-centered medical home.
abstract: The purpose of this study was to implement and evaluate a care delivery model integrating the registered nurse-certified diabetes educator into the patient-centered medical home to assist in achieving positive clinical and cost outcomes in diabetes care.
  
  
  
  A 1-group pretest-posttest research design was used. Patients were recruited from 2 patient-centered medical home designated/nominated primary care offices. Inclusion criteria were as follows: diagnosis of type 1 or type 2 diabetes, aged 18 to 80 years, A1C ≥ 8%, English speaking, and no diabetes education within 6 months. There were 34 participants (men, n = 22; women, n = 12) with a mean age of 53.24. The intervention incorporated an assessment, 4 patient-centered monthly group sessions, and 4 individual follow-up sessions. Study measures included program surveys, participation and satisfaction rates, Healthcare Effectiveness Data and Information Set attainment rates, and the following physiologic measures obtained from the medical record: A1C, fasting blood glucose, LDL, urine microalbumin, blood pressure, retinal eye exam, and body mass index. Cost-effectiveness measures included program costs, performance incentives, revenue, provider time saved, and patient health care utilization.
  
  
  
  Paired-samples t tests identified significant improvements in A1C, fasting blood glucose, and LDL. Patients and providers were highly satisfied with the program. Cost-benefit analysis revealed a net pretax program benefit.
  
  
  
  Results of the study indicated that integrating the registered nurse-certified diabetes educator in the patient-centered medical home improves clinical outcomes and is cost-effective. Diabetes education and support are integral components of diabetes management.
authors.affiliation: The Graduate School, Madonna University, Livonia, Michigan (Ms Moran, Ms Burson)
authors.forename: Katherine
authors.initials: K
authors.lastname: Moran
authors.affiliation: The Graduate School, Madonna University, Livonia, Michigan (Ms Moran, Ms Burson)
authors.forename: Rosanne
authors.initials: R
authors.lastname: Burson
authors.affiliation: The School of Business, Madonna University, Livonia, Michigan (Dr Critchett, Dr Olla)
authors.forename: John
authors.initials: J
authors.lastname: Critchett
authors.affiliation: The School of Business, Madonna University, Livonia, Michigan (Dr Critchett, Dr Olla)
authors.forename: Phillip
authors.initials: P
authors.lastname: Olla
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000191:economics / Q000451:nursing*; D005260:Female; D040441:Health Educators / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics / Q000458:organization & administration*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D012648:Self Care; D016896:Treatment Outcome; D014481:United States