Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2009 Oct 26;169(19):1788-94.
doi: 10.1001/archinternmed.2009.338.

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 mellitus: a randomized controlled trial

Tiffany L Gary  1 , Marian Batts-Turner, Hsin-Chieh Yeh, Felicia Hill-Briggs, Lee R Bone, Nae-Yuh Wang, David M Levine, Neil R Powe, Christopher D Saudek, Martha N Hill, Maura McGuire, Frederick L Brancati
Affiliations
Randomized Controlled Trial

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 mellitus: a randomized controlled trial

Tiffany L Gary et al. Arch Intern Med. .

Abstract

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 downward arrow 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.

PubMed Disclaimer

Figures

Figure
Figure
Flowchart of participants. CHW indicates community health worker; DM, diabetes mellitus; NCM, nurse case manager.
See this image and copyright information in PMC

References

    1. Robbins JM, Vaccarino V, Zhang H, Kasl SV. Excess type 2 diabetes in African-American women and men aged 40–74 and socioeconomic status: evidence from the Third National Health and Nutrition Examination Survey. J Epidemiol Community Health. 2000;54(11):839–845. - PMC - PubMed
    1. Brancati FL, Kao WHL, Folsom AR, Watson RL, Szklo M. Incident type 2 diabetes mellitus in African Americans and white adults: the Atherosclerosis Risk in Communities Study. JAMA. 2000;283(17):2253–2259. - PubMed
    1. Krop JS, Coresh J, Chambless LE, et al. A community-based study of explanatory factors for the excess risk for early renal function decline in blacks vs whites with diabetes: the Atherosclerosis Risk in Communities Study. Arch Intern Med. 1999;159(15):1777–1783. - PubMed
    1. National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics Fact Sheet: General Information and National Estimates on Diabetes in the United States. Bethesda, MD: National Institutes of Health; 2005. (NIH Publication 06-3892).
    1. Tull ES, Roseman JM. Diabetes in African Americans. In: National Diabetes Data Group of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, editor. Diabetes in America. 2nd. Bethesda, MD: National Diabetes Data Group of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; 1995. pp. 613–629. (Publication 95-1468).

Publication types

MeSH terms

Associated data