Intensive intervention strategy reduced ED visits, HbA1c levels for black patients with diabetes

An intervention tailored to black patients with diabetes and conducted by a nurse case manager and community health worker reduced visits to the emergency department by 23% compared with patients who underwent a minimal intervention strategy.

Researchers randomly assigned 542 black patients with type 2 diabetes from an urban managed care organization to either an intensive or minimal intervention program.

Those assigned to minimal intervention received mailings and telephone calls every six months reminding them about preventive screenings. Those patients assigned to the intensive intervention strategy received the same components as the minimal intervention group, and in addition, received individualized, culturally tailored care from a nurse case manager and a community health worker who followed up with and provided feedback to patients’ primary care providers.

Researchers reported favorable reductions in mean HDL and diastolic blood pressure for the intensive intervention group patients (P<.05); however, no other significant within-group or between-group changes were noted for clinical characteristics.

Those patients who had four or more visits with a case health worker demonstrated a greater decline in HbA1c even if they had fewer than two visits with the nurse case manager, although this finding was not statistically significant (P=.06). Those patients who had more visits with both a case health worker and nurse case manager demonstrated a decline in HbA1c level compared with the minimal intervention group (P=.03), but this finding became nonsignificant after adjustment (P=.12).

At two years, the intensive intervention treatment group had fewer ED visits than the minimal intervention group (RR=0.77; 95% CI, 0.59-1.00). Those who had more frequent visits with the nurse case manager and case health worker demonstrated a 34% reduction in visits vs. the minimal intervention group. The intensive intervention group also had a rate reduction of 9% for hospitalizations compared with the minimal intervention group. The researchers noted that the overall results for ED visits and hospitalizations in the intensive intervention group at three years were similar to the two-year results.

Gary TL. Arch Intern Med. 2009;169:1788-1794.