$3 Million Grant Funds Nurse Case Management and Diabetic Patient Study
Press Release - October 12, 2005
Hershey, Pa. -- A Penn State Milton S. Hershey Medical Center-led team has been awarded a five-year, $3 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, to study whether enhanced nursing care in the primary care setting can reduce sickness and death from complications of Type 2 diabetes.
"Achieving and maintaining certain goals for blood glucose levels, blood pressure, cholesterol, exercise and more have already been shown to reduce or prevent the incidence of complications of diabetes such as heart disease, kidney failure, blindness and amputations," said Robert A. Gabbay, M.D., Ph.D., principle investigator for the project, co-director of Penn State Diabetes Center, and associate professor of medicine, Penn State College of Medicine, Penn State Hershey Medical Center. "National surveys indicate, however, that the majority of patients fall short on these goals and we believe the reason to stem from challenges with the primary care system."
Some of these challenges include lack of adequate time physicians are able to spend with patients, patient adherence to recommended testing and treatment strategies, and some resistance to following nationally-recognized guidelines set by the American Diabetes Association, American Heart Association, etc. Gabbay's study will determine if enhanced nurse case management can counteract some of these barriers to encourage optimal diabetes care.
In the study, patients from 12 primary care clinics in the Hershey and Reading, Pa., areas will be randomized into two groups. (The 12 clinics include all nine Penn State Hershey-affiliated general internal medicine and family medicine primary care facilities that are part of the Penn State Ambulatory Research Network, and three additional clinics in Reading that provide care to an underserved Hispanic population.) For three years, one group will receive usual care, and the other group of patients will receive enhanced nursing case management intervention during regular office visits. This will include individualized behavior change counseling using a new technique called motivational interviewing to encourage patient adherence to diet and ensure appropriate blood sugar checks, medication dosing and exercise. A detailed curriculum will be developed to train nurses in optimal diabetes care. Nurses will work closely with primary care physicians to help patients with diabetes achieve the established goals for care that have already been shown to prevent the potentially devastating complications of diabetes.
"One focus of the study is to test the effectiveness of nurse case management on the Hispanic population, which has a much higher incidence of diabetes," Gabbay said. "In fact, 10.2 percent of Hispanics have diabetes and, according to statistics, half of all Hispanic girls born in the year 2000 will develop diabetes in their lifetimes. In our study, about 38 percent of participants will be Hispanic, providing us with an opportunity to see how these nurse case management interventions might improve health outcomes for this often underserved minority population."
Along with monitoring the health of all participants over the three years, the study will measure cost-effectiveness of the enriched nurse case management intervention by tracking whether those receiving the interventions experience fewer hospital admissions, fewer heart attacks, and fewer emergency room visits. The study will also track whether those in the intervention group have improved quality of life, patient satisfaction and self-management behaviors.
"People often are fearful of low blood sugars and developing complications, and have concerns that they're not getting adequate help, feelings of powerlessness, depression and more," Gabbay said. "We want to see if these interventions cause improved adherence to self-care guidelines, higher quality of life and lower levels of diabetes specific emotional distress. We also feel that these interventions may have a positive impact on provider satisfaction because many physicians too are frustrated with the current system that gives them little time to provide the care that they want." Ultimately, Gabbay hopes this study will give health care providers, payers, and policymakers a valuable model of how to improve the care of patients with diabetes in the primary care setting, and give those with diabetes the tools and encouragement to take good care of themselves between doctors' appointments.
The study involves collaboration of a large number of Penn State and outside collaborators: Alan Adelman, M.D., director of the Primary Care Research Network and professor of family and community medicine; Cheryl Dellasega, G.N.P., Ph.D., professor of medicine; Irina Lendel, M.D., Mary Collins, C.D.E., Division of Endocrinology, Diabetes and Metabolism; Chris Hollenbeak, Ph.D., assistant professor of health evaluation sciences; and David T. Mauger, Ph.D., associate professor of health evaluation sciences, Penn State College of Medicine; David Johnson, Ph.D., Penn State Center for Survey Research at Penn State University Park; David George, M.D., and Tipu Faiz Saleem, M.D., internal medicine, Reading Hospital, Reading, Pa.; Deborah Van Horne, Ph.D., University of Pennsylvania; Carol Horowitz, M.D., M.P.H., Mt. Sinai School of Medicine; Eric Ford, Ph.D., Tulane University; Garry Welch, M.D., Baystate Medical Center; and Robert Weech-Maldonado, M.B.A., Ph.D., University of Florida, Gainesville.
For more information about the study, patients may call (717) 531-3592. For more information about Penn State Diabetes Center, visit the Web site at http://www.pennstatediabetescenter.com .