J Clin Outcomes Manage
Evaluation of a diabetes case management intervention in an underserved population: a retrospective cohort study at a heatlh disparities collaborative site
Sekhobo JP, Wang C, Ferrari P
Abstract Objective: To evaluate the impact of case management on glycemic control in a predominantly low-income, minority patient population receiving care at a multisite community health center. Methods: The case management intervention was implemented at a Health Disparities Collaborative site in 2002. A control clinic that that did not have case management but belonged to the same network as the intervention clinic was used for comparison. Type 2 diabetes patients who had 4 or more documented glycosylated hemoglobin (HbA1c) test results from 1 January 2003 through 31 December 2005 comprised the study sample (n = 132). Baseline predictor variables included sociodemographic characteristics, weight status, insurance coverage, hypertension status, medication status, and case management. Results: Regardless of site, participants with poor glycemic control at baseline (HbA1c ? 9.0%) tended to experience the greatest reductions in HbA1c, with the mean HbA1c declining from 11.0% during the baseline visit to 9.1% during the fourth visit. In repeated-measures multivariate analysis of variance, statistically significant differences were detected between overall mean HbA1c values in the categories of case management status (F = 42.15, p ? 0.001), baseline glycemic control (F = 6.07, p = 0.0157), treatment status (F = 5.87, P = 0.0011), and race/ethnicity (F = 3.77, p = 0.0134). Tests for within-subject effects did not produce a statistically significant effect of visit (F3,86 = 0.92, p = 0.4547). Conclusion: These results provide preliminary evidence of the effectiveness of a collaborative case management intervention in a predominantly low-income, minority study population. These findings should be confirmed in larger studies of pooled community health center data.
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