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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 MellitusA Randomized Controlled Trial
Tiffany L. Gary, PhD, MHS;
Marian Batts-Turner, MSN, RN, CDE;
Hsin-Chieh Yeh, PhD;
Felicia Hill-Briggs, PhD;
Lee R. Bone, MPH, RN;
Nae-Yuh Wang, PhD;
David M. Levine, MD, MPH, ScD;
Neil R. Powe, MD, MBA, MPH;
Christopher D. Saudek, MD;
Martha N. Hill, PhD, RN;
Maura McGuire, MD;
Frederick L. Brancati, MD, MHS
Arch Intern Med. 2009;169(19):1788-1794.
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  34%).
Conclusion 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.
Trial Registration clinicaltrials.gov Identifier: NCT00022750
Author Affiliations: Departments of Epidemiology (Drs Gary, Yeh, Powe, and Brancati), Medicine (Drs Gary, Yeh, Hill-Briggs, Wang, Levine, Saudek, McGuire, and Brancati and Ms Batts-Turner), Health, Behavior, and Society (Dr Hill-Briggs and Ms Bone), and Health Policy and Management (Drs Levine and Powe) and School of Nursing (Dr Hill), The Johns Hopkins Medical Institutions, Baltimore, Maryland.
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