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Randomized Controlled Trial
. 2014 Jul;29(4):308-14.
doi: 10.1097/JCN.0b013e3182945243.

Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities

Jerilyn K Allen  1 , Cheryl R Dennison Himmelfarb, Sarah L Szanton, Kevin D Frick
Affiliations
Randomized Controlled Trial

Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities

Jerilyn K Allen et al. J Cardiovasc Nurs. 2014 Jul.

Abstract

Background: Although evidence-based guidelines on the management of cardiovascular disease (CVD) and type 2 diabetes have been widely published, implementation of recommended therapies is suboptimal.

Objective: The aim of this study was to evaluate the cost-effectiveness of a comprehensive program of CVD risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams versus enhanced usual care to improve lipids, blood pressure (BP), and hemoglobin (Hb) A1c levels in patients in urban community health centers.

Methods: A total of 525 patients with documented CVD, type 2 diabetes, hypercholesterolemia, or hypertension and levels of low-density lipoprotein cholesterol, BP, or Hb A1c that exceeded goals established by national guidelines were randomized to NP/CHW (n = 261) or enhanced usual care (n = 264) groups. Cost-effectiveness ratios were calculated, determining costs per percent and unit change in the primary outcomes.

Results: The mean incremental total cost per patient (NP/CHW and physician) was only $627 (confidence interval, 248-1015). The cost-effectiveness of the 1-year intervention was $157 for every 1% drop in systolic BP and $190 for every 1% drop in diastolic BP, $149 per 1% drop in Hb A1c, and $40 per 1% drop in low-density lipoprotein cholesterol.

Conclusions: The findings suggest that management by an NP/CHW team is a cost-effective approach for community health centers to consider in improving the care of patients with existing CVD or at high risk for the development of CVD.

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Figures

Figure 1
Figure 1
COACH Flow Diagram
Figure 2
Figure 2
Percentage of intervention time by task
See this image and copyright information in PMC

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