Objective: The objective of this study was to determine if the nurse case management (NCM) program implemented at VGMHC improved glycemic control (HbA1c), home glucose monitoring (HGM), foot checks, and appointments scheduled versus attended (ASVA ratio) among low income/farm worker Hispanic diabetics.
Research Design and Methods: This is a retrospective cohort study. A comprehensive list of patietns was identified via the clinic diabetes registry and patients were then selected in a random fashion. Chart review was performed to identify those patients that met study inclusion criteria. All patients had to be Hispanic and each patient had a HbA1c during the six months prior and six months after the implementation of the nurse case management program. There were a total of 40 subjects comprising two groups, those exposed to NCM and those not exposed to NCM. Data was collected by chart review and analyzed using descriptive statistics on a Microsoft Excel spreadsheet.
Results: Patients in the NCM group had a mean increase in HbA1c of 0.58 while those in the non-exposed group decreased by a mean 0.59. Subgroup analysis based o insulin use reveals similar results. The NCM group did have improvements in HGM, foot checks, and ASVA ratio at 25%, 10%, and -0.13 respectively. The non-exposed group worsened for the same categories by 10%, 15%, +0.18 respectively.
Conclusions: The results of this study show that NCM did improve process measures defined as HGM, foot checks, and attendance of appointments compared to their cohorts that did not receive NCM. However, HbA1c levels did not follow this trend of improvement through the program.
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