Allen Jerilyn K, Dennison Himmelfarb Cheryl R, Szanton Sarah L, Frick Kevin D
Jerilyn K. Allen, RN, ScD, FAAN M Adelaide Nutting Professor of Nursing, Public Health and Medicine and Associate Dean for Research, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Cheryl R. Dennison Himmelfarb, RN, ANP, PhD, FAAN Associate Professor, School of Nursing and Medicine, Johns Hopkins University, Baltimore, Maryland. Sarah L. Szanton, PhD, CRNP Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Kevin D. Frick, PhD, MA Professor, Bloomberg School of Public Health and School of Nursing, Johns Hopkins University, Baltimore, Maryland.
J Cardiovasc Nurs. 2014 Jul;29(4):308-14. doi: 10.1097/JCN.0b013e3182945243.
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.
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.
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.
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.
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.
尽管关于心血管疾病（CVD）和2型糖尿病管理的循证指南已广泛发布，但推荐疗法的实施情况仍不尽人意。
本研究旨在评估由执业护士/社区卫生工作者（NP/CHW）团队提供的综合心血管疾病风险降低项目与强化常规护理相比，在改善城市社区卫生中心患者血脂、血压（BP）和糖化血红蛋白（Hb）A1c水平方面的成本效益。
共有525例患有记录在案的心血管疾病、2型糖尿病、高胆固醇血症或高血压且低密度脂蛋白胆固醇、血压或糖化血红蛋白水平超过国家指南设定目标的患者被随机分为NP/CHW组（n = 261）或强化常规护理组（n = 264）。计算成本效益比，确定主要结局每百分比和单位变化的成本。
每位患者（NP/CHW和医生）的平均增量总成本仅为627美元（置信区间，248 - 1015）。1年干预的成本效益为收缩压每下降1%为157美元，舒张压每下降1%为190美元，糖化血红蛋白每下降1%为149美元，低密度脂蛋白胆固醇每下降1%为40美元。
研究结果表明，对于社区卫生中心而言，NP/CHW团队管理是一种具有成本效益的方法，可用于改善现有心血管疾病患者或心血管疾病高危患者的护理。
