DYNAMIC Study: (Diabetes Nurse Case Management And Motivational Interviewing for Change)
Although strong clinical evidence exists that patients with diabetes should achieve certain clinical goals (i.e. HbA1C, BP, LDL, etc.), to reduce morbidity and mortality national surveys indicate that only a minority of people with diabetes achieves these goals.
Hypothesis: combination of nurse case management and enhanced behavior change counseling will improve outcomes for glycemic control, blood pressure and cholesterol in high risk patients with Type 2 diabetes when compared to usual care over a 3 year period.
Study design- The study will be a three year randomized control trial that will select patients that have either A1C >8.5, LDL >130, or BP >140/90. Nurse case managers, trained in clinical guidelines and brief behavior change counseling techniques (motivational interviewing), will aim to foster patient adherence in the experimental group patients. Nurse case managers will use standing orders to set an implementation of clinical guidelines (for diabetes, hypertension, hyperlipidemia and depression) with individual follow up.
A total of 820 patients between the all 9 (6 Hershey Medical Center and 3 Reading Hospital affiliated clinics) will be sought. One third of the study patients will be recruited from the underserved Hispanic population in the Reading area. Patients will be randomized by physician i.e. one physician will be randomly assigned to have all their patients co-managed by a nurse case manager; the other will have usual care without any contact with nurse case manager.
Nurses will be trained and then initiate a small pilot study in July thru August. Full recruitment and initiation of study will begin in September 2006.
Clinic Activities - Each nurse will be responsible for 3 clinics. Nurses will work under the supervision of the primary care physicians. A set of clinical guidelines will be developed with physician input that will serve as the over-riding framework for the nurses.
Outcomes - Over a three-year period the investigators will evaluate clinical response (improvements in A1C, BP, LDL, and depression when present) as well as a series of other measures that will be obtained by surveys (patient satisfaction, quality of life, self-management behaviors). Provider satisfaction will be measured using a standardized tool. Finally, cost effectiveness of the intervention and evaluation of the potential barriers to implementation will be studied.
Behavioral: Nurse Case Management intervention
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Impact of Nurse Case Management on Diabetes Co-morbidities|
- % of patients reaching goal HbA1C (<7) [ Time Frame: 2 years after enrollment ]
- % of patients with BP goal (<130/80) [ Time Frame: Two years after enrollment ]
- % of patients with LDL at goal (<100) [ Time Frame: 2 years after enrollment ]
- % of patients at goal for all three parameters (HbA1C <7, BP <130/80, LDL <100) [ Time Frame: 2 years after enrollment ]
- % of patients with yearly ophthalmologic exam [ Time Frame: 2 years after enrollment ]
- % of patients with yearly foot exam [ Time Frame: 2 years after enrollment ]
- % of patients with assessment for nephropathy [ Time Frame: 2 years after enrollment ]
- % of patients with nephropathy on ACE inhibitor or ARB [ Time Frame: 2 years after enrollment ]
- % of patients on aspirin [ Time Frame: 2 years after enrollment ]
- % of patients at or above CES-D depression score 16 for severe depression [ Time Frame: 2 years after enrollment ]
- Change in weight [ Time Frame: 2 years after enrollment ]
- Emotional distress (PAID survey) [ Time Frame: 2 years after enrollment ]
- Diabetes specific quality of life (ADD QOL) [ Time Frame: 2 years after enrollment ]
- Diabetes self care activities survey [ Time Frame: 2 years after enrollment ]
- Patient satisfaction survey (DTSQ) [ Time Frame: 2 years after enrollment ]
- Costs and cost-effectiveness [ Time Frame: 2 years after enrollment ]
- Physician satisfaction - survey filled out by physician [ Time Frame: 2 years after enrollment ]
|Study Start Date:||August 2006|
|Estimated Study Completion Date:||August 2010|
|Estimated Primary Completion Date:||August 2010 (Final data collection date for primary outcome measure)|
Behavioral: Nurse Case Management intervention
Please refer to this study by its ClinicalTrials.gov identifier: NCT00308386
|United States, Pennsylvania|
|Penn State College of Medicine|
|Hershey, Pennsylvania, United States, 17033|
|Reading, Pennsylvania, United States, 19612|
|Principal Investigator:||Robert Gabbay, MD, PhD||Penn State College of Medicine|