Clinical studyCase management for patients with poorly controlled diabetes: a randomized trial☆
Section snippets
Methods
This study was conducted as a prospective, randomized controlled trial at two academically affiliated Department of Veterans Affairs (VA) Medical Centers: a suburban facility that cares for approximately 3000 veterans with diabetes and an inner-city facility that cares for over 4000 veterans with diabetes. Approval was obtained from Institutional Review Boards at the Ann Arbor VA Healthcare System and Wayne State University.
Using automated clinical data from each facility, we identified
Results
The baseline attributes of the intervention and control groups were similar (Table 1). Except for having a higher percentage of nonwhite participants, study enrollees were demographically representative of VA ambulatory patients. Patients who refused to participate tended to be older than the study participants (mean age, 66 years) and had higher mean HbA1C values (10.1%). Clinically, study participants had poor glycemic control, low physical and mental health scores, and high comorbidity.
Mean
Discussion
Innovative approaches to improve outcomes and decrease costs for persons with chronic health conditions are an increasingly important part of health care. Accordingly, care models such as case management are being actively promoted 26, 27, 32, 45. However, evidence to support the effectiveness of such strategies has been limited, especially for more ill and socially disadvantaged patients (22). This study examined the implementation and effectiveness of an outpatient-based, collaborative case
Acknowledgements
The authors would like to thank Barb Fredrick and Christine Weglarz for their invaluable assistance throughout the course of this study, and Bill Herman and Morris Weinberger for their contributions and encouragement especially during the early stages of the study. We would like to acknowledge Jennifer Davis for her help with obtaining data and Judy Fox for conducting the semistructured interviews and assisting with the qualitative analysis.
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This research was supported by the Office of Research and Development, Health Services Research and Development Service, Department of Veterans Affairs (IIR 970771). This work was also supported in part by the Michigan Diabetes Research and Training Center Grant P60DK-20572 from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, Bethesda, Maryland. Dr. Vijan is a Department of Veterans Affairs Career Development Awardee. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.