Davidson Mayer B, Ansari Adeela, Karlan Vicki J
Clinical Center for Research Excellence, Charles R. Drew University, 1731 East 120th St., Los Angeles, CA 90059, USA.
Diabetes Care. 2007 Feb;30(2):224-7. doi: 10.2337/dc06-2022.
To evaluate whether nurse-directed diabetes care reduced preventable diabetes-related urgent care/emergency room visits and hospitalizations in a minority population.
Diabetic patients who receive care in a county public health clinic were randomly selected for a Diabetes Managed Care Program (DMCP) in which a specially trained nurse followed detailed treatment algorithms to provide diabetes care for 1 year. Preventable diabetes-related urgent care/emergency room visits and hospitalizations for these patients incurred during the intervention year and the year before enrollment were compared. Preventable diabetes-related causes were defined as metabolic (diabetic ketoacidosis, hyperglycemia, or hypoglycemia) or infection (cellulitis, foot ulcer, osteomyelitis, fungal infection, or urinary tract infection).
Use of the urgent care/emergency room and hospitalizations during the intervention year and the year prior were available for 331 patients who completed the DMCP intervention. There were 95 [corrected] total urgent care/emergency room visits and hospitalizations in the year before entering the DMCP and 52 [corrected] during the DMCP year, a 45[corrected]% reduction. Preventable diabetes-related episodes were far fewer. During the prior year, 14 patients made 15 urgent care/emergency room visits and 5 patients incurred 6 hospitalizations. During the DMCP year, four different patients made five emergency room/urgent care visits and one other patient was hospitalized. Preventable diabetes-related use was significantly (P < 0.001) lower during the intervention year compared with the prior year. Total charges for urgent care/emergency room visits and hospitalizations only (not other charges related to diabetes care) during the year before entering the DMCP were $129,176 compared with $24,630 during the DMCP year.
When compared with usual care, nurse-directed diabetes care resulted in significantly fewer urgent care/emergency room visits and hospitalizations for preventable diabetes-related causes. Policy makers seeking to improve diabetes care and conserve resources should seriously consider adopting this approach.
评估由护士主导的糖尿病护理是否能减少少数族裔人群中可预防的糖尿病相关紧急护理/急诊室就诊及住院情况。
从一家县公共卫生诊所接受护理的糖尿病患者中随机选取，纳入糖尿病管理护理项目（DMCP），在该项目中，一名经过专门培训的护士遵循详细的治疗算法提供为期1年的糖尿病护理。比较这些患者在干预年以及入组前一年发生的可预防的糖尿病相关紧急护理/急诊室就诊及住院情况。可预防的糖尿病相关病因定义为代谢性（糖尿病酮症酸中毒、高血糖或低血糖）或感染性（蜂窝织炎、足部溃疡、骨髓炎、真菌感染或尿路感染）。
331名完成DMCP干预的患者提供了干预年及前一年的紧急护理/急诊室就诊及住院情况。进入DMCP前一年共有95次[校正后]紧急护理/急诊室就诊及住院，而在DMCP年为52次[校正后]，减少了45%[校正后]。可预防的糖尿病相关事件要少得多。前一年，14名患者进行了15次紧急护理/急诊室就诊，5名患者住院6次。在DMCP年，4名不同患者进行了5次急诊室/紧急护理就诊，另有1名患者住院。与前一年相比，干预年可预防的糖尿病相关就诊显著减少（P < 0.001）。进入DMCP前一年仅紧急护理/急诊室就诊及住院的总费用（不包括与糖尿病护理相关的其他费用）为129,176美元，而DMCP年为24,630美元。
与常规护理相比，由护士主导的糖尿病护理可使可预防的糖尿病相关病因导致的紧急护理/急诊室就诊及住院显著减少。寻求改善糖尿病护理并节约资源的政策制定者应认真考虑采用这种方法。
