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Effectiveness of Diabetes Resource Nurse Case Management and Physician Profiling in a Fee-For-Service Setting: A Cluster Randomized Trial
Open accessAbstract
Nurses with advanced training-diabetes resource nurses (DRNs)-can improve care for people with diabetes in capitated payment settings. Their effectiveness in fee-for-service settings has not been investigated. We conducted a 12-month practice-randomized trial involving 22 practices in a fee-for-service metropolitan network with 92 primary care physicians caring for 1891 Medicare patients ≥65 years with diabetes mellitus. Each practice was randomized to one of three intervention groups: physician feedback on process measures using Medicare claims data; Medicare claims feedback plus feedback on clinical measures from medical record (MR) abstraction; or both types of feedback plus a practice-based DRN. The primary endpoint investigated was hemoglobin A(1c) level. Other measures were low-density lipoprotein (LDL) cholesterol level, blood pressure, annual hemoglobin A(1c) testing, annual LDL screening, annual eye exam, annual foot exam, and annual renal assessment. Data were collected from medical chart abstraction and Medicare claims. The number of patients with hemoglobin A(1c) <9% increased by 4 (0.9%) in the Claims group; 9 (2.1%) in the Claims + MR group (comparison with Claims: P = 0.97); and 16 (3.8%) in the DRN group (comparison with Claims: P = 0.31). Results were similar for the other clinical outcomes, with no differences significant at P = 0.10. For process of care measures, decreases were seen in all groups, with no significant differences in change scores. Quality improvement strategies must be evaluated in the appropriate setting. Initiatives that have been effective in capitated systems may not be effective in fee-for-service environments.
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Herrin 2006 found no statistically significant difference in the proportion of adequate glucose control when adding patient-specific clinical data from medical records to administrative data feedback (adjusted RD = 1.9%, patient outcome; P = 0.97).
“They also did not find a statistically significant difference in the proportion of adequate glucose control (adjusted RD = 1.9%, patient outcome; P = 0.97).”
From Audit and feedback: effects on professional practice and healthcare outcomes (2012) · cites this paper as Herrin 2006
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Metadata
- Authors
- Herrin, J., Nicewander, D. A., Hollander, P. A., Couch, C. E., Winter, F. D., Haydar, Z. R., Warren, S. S., & Ballard, D. J.
- Corresponding author
- Ballard, David J.
- Venue
- Baylor University Medical Center Proceedings
- Publisher
- Informa UK Limited
- Published
- 2006-04
- Volume
- 19
- Issue
- 2
- Pages
- 95-102
- ISSN
- 0899-8280 (ISSN-L)
- 1525-3252
- PMC
- PMC1426180
- OpenAlex
- W1605633581
- Cited by
- 16
- References
- 45
- Citations by year
- 2025: 1 · 2023: 1 · 2020: 1 · 2019: 1 · 2018: 2 · 2016: 1 · 2015: 2 · 2013: 1 · 2012: 2
- FWCI
- 0.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Baylor University Medical Center Proceedings (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kaiser Permanente
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- nurse case management, physician profiling, fee-for-service, Medicare beneficiaries, diabetes mellitus, glycemic control, HbA1c, primary care, physician feedback, quality improvement, process of care
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