title: Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities.
abstract: BACKGROUND
  Although evidence-based guidelines on the management of cardiovascular disease (CVD) and type 2 diabetes have been widely published, implementation of recommended therapies is suboptimal.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the cost-effectiveness of a comprehensive program of CVD risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams versus enhanced usual care to improve lipids, blood pressure (BP), and hemoglobin (Hb) A1c levels in patients in urban community health centers.
  
  
  METHODS
  A total of 525 patients with documented CVD, type 2 diabetes, hypercholesterolemia, or hypertension and levels of low-density lipoprotein cholesterol, BP, or Hb A1c that exceeded goals established by national guidelines were randomized to NP/CHW (n = 261) or enhanced usual care (n = 264) groups. Cost-effectiveness ratios were calculated, determining costs per percent and unit change in the primary outcomes.
  
  
  RESULTS
  The mean incremental total cost per patient (NP/CHW and physician) was only $627 (confidence interval, 248-1015). The cost-effectiveness of the 1-year intervention was $157 for every 1% drop in systolic BP and $190 for every 1% drop in diastolic BP, $149 per 1% drop in Hb A1c, and $40 per 1% drop in low-density lipoprotein cholesterol.
  
  
  CONCLUSIONS
  The findings suggest that management by an NP/CHW team is a cost-effective approach for community health centers to consider in improving the care of patients with existing CVD or at high risk for the development of CVD.
authors: Jerilyn K. Allen, RN, ScD, FAAN M Adelaide Nutting Professor of Nursing, Public Health and Medicine and Associate Dean for Research, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Cheryl R. Dennison Himmelfarb, RN, ANP, PhD, FAAN Associate Professor, School of Nursing and Medicine, Johns Hopkins University, Baltimore, Maryland. Sarah L. Szanton, PhD, CRNP Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Kevin D. Frick, PhD, MA Professor, Bloomberg School of Public Health and School of Nursing, Johns Hopkins University, Baltimore, Maryland.
authors: Jerilyn K
authors: JK
authors: Allen
authors: Cheryl R
authors: CR
authors: Dennison Himmelfarb
authors: Sarah L
authors: SL
authors: Szanton
authors: Kevin D
authors: KD
authors: Frick
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics* / Q000451:nursing*; D064646:Cardiovascular Nursing / Q000458:organization & administration*; D003153:Community Health Services / Q000191:economics*; D003150:Community Health Workers / Q000458:organization & administration*; D055812:Community-Based Participatory Research; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000451:nursing; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D006937:Hypercholesterolemia / Q000191:economics / Q000451:nursing; D006973:Hypertension / Q000191:economics / Q000451:nursing; D008297:Male; D008875:Middle Aged
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