title: RN Diabetes Virtual Case Management: A New Model for Providing Chronic Care Management.
abstract: The U.S. chronic disease health care system has substantial gaps in delivery of services. New models of care change traditional delivery of care and explore new settings for care. This article describes a new model of diabetes chronic care delivery: nurse-delivered care that includes protocol-based insulin titration and patient education delivered solely in a virtual environment. In phase 1, the clinical outcome of time to achievement of glycated hemoglobin (A(1C)) goals (P < .001; 95% confidence interval, 1.68-2.24) was significantly improved by registered nurse (RN) standing order intervention (n = 24) as compared with historical controls (n = 28). In phase 2, patients who were referred to an RN-managed insulin titration protocol with individualized A(1C) goals had a significant (P < .001; 95% confidence interval, 1.680-2.242) reduction in results from a mean of 9.6% at baseline to 7.7% at completion. Average patient age was 66 years, with a mean duration of 11 years diagnosed with diabetes. Safety was demonstrated by the absence of hypoglycemia related to RN protocol adjustment. There were no admissions or emergency room (ER) visits for hypoglycemia. This study demonstrates safety and efficacy of RN virtual chronic disease management for an older population of patients with long-standing diabetes.
authors.affiliation: Mann-Grandstaff Veterans Administration (VA) Medical Center (11AC), Spokane, Washington (Mss Brown and Carrara); Louis Stokes Cleveland VA Medical Center (W-111), Cleveland, Ohio (Dr Watts); and Veterans Health Administration (VHA) Office of Nursing Services (10A1), Washington, District of Columbia (Dr Lucatorto).
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Brown
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Carrara
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Watts
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Lucatorto
mesh_terms: D000368:Aged; D003695:Delivery of Health Care; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000451:nursing*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D016294:Models, Nursing; D015397:Program Evaluation; D019114:Remote Consultation / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin