Diabetes nurse case management and motivational interviewing for change (DYNAMIC)

Study design and baseline characteristics in the Chronic Care Model for type 2 diabetes

Heather Stuckey, Cheryl Dellasega, Nora J. Graber, David Mauger, Irina Lendel, Robert A. Gabbay

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Despite evidence that diabetes is costly and devastating, the health care system is poorly equipped to meet the challenges of chronic disease care. The Penn State Institute of Diabetes & Obesity is evaluating a model of managing type 2 DM which includes nurse case management (NCM) and motivational interviewing (MI) to foster behavior change. The primary care intervention is designed to improve patients' self care and to reduce clinical inertia through provider use of standardized clinical guidelines to achieve better diabetes outcomes. Methods: This RCT tests the efficacy of an enhanced NCM intervention on type 2 DM (n = 549) patient outcomes mediated by changes in self-care behavior and diabetes management. Outcome measures include: (a) effect on clinical parameters such as HbA1c (< 7), BP (< 130/80), and LDL (< 100), depression scores and weight; (b) process measures such as complication screening; (c) patient psychological and behavioral outcomes as measured by emotional distress (PAID), diabetes-specific quality of life (ADDQoL), patient satisfaction (DTSQ), self-care activities (SDSCA); and (d) physician satisfaction and cost-effectiveness of the intervention. Conclusions: Baseline includes (mean) age = 58; BMI = 34.4; 57% females; 47% Caucasian, and 39% Hispanic. Patients had elevated HbA1c (8.4), BP (137/77) and LDL (114). Overall, patients were depressed (CES-D = 21.6) and had an extremely negative quality of life (ADDQoL = - 1.58). We believe that enhanced NCM will both improve self-care and reduce emotional distress for patients with diabetes. If proven effective, enhanced NCM may be translated to other chronic illnesses.

Original languageEnglish (US)
Pages (from-to)366-374
Number of pages9
JournalContemporary Clinical Trials
Volume30
Issue number4
DOIs
StatePublished - Jul 1 2009

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Motivational Interviewing
Case Management
Type 2 Diabetes Mellitus
Self Care
Nurses
Quality of Life
Chronic Disease
Process Assessment (Health Care)
Patient Satisfaction
Hispanic Americans
Cost-Benefit Analysis
Primary Health Care
Patient Care
Obesity
Outcome Assessment (Health Care)
Guidelines
Depression
Psychology
Delivery of Health Care
Physicians

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

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title = "Diabetes nurse case management and motivational interviewing for change (DYNAMIC): Study design and baseline characteristics in the Chronic Care Model for type 2 diabetes",
abstract = "Background: Despite evidence that diabetes is costly and devastating, the health care system is poorly equipped to meet the challenges of chronic disease care. The Penn State Institute of Diabetes & Obesity is evaluating a model of managing type 2 DM which includes nurse case management (NCM) and motivational interviewing (MI) to foster behavior change. The primary care intervention is designed to improve patients' self care and to reduce clinical inertia through provider use of standardized clinical guidelines to achieve better diabetes outcomes. Methods: This RCT tests the efficacy of an enhanced NCM intervention on type 2 DM (n = 549) patient outcomes mediated by changes in self-care behavior and diabetes management. Outcome measures include: (a) effect on clinical parameters such as HbA1c (< 7), BP (< 130/80), and LDL (< 100), depression scores and weight; (b) process measures such as complication screening; (c) patient psychological and behavioral outcomes as measured by emotional distress (PAID), diabetes-specific quality of life (ADDQoL), patient satisfaction (DTSQ), self-care activities (SDSCA); and (d) physician satisfaction and cost-effectiveness of the intervention. Conclusions: Baseline includes (mean) age = 58; BMI = 34.4; 57{\%} females; 47{\%} Caucasian, and 39{\%} Hispanic. Patients had elevated HbA1c (8.4), BP (137/77) and LDL (114). Overall, patients were depressed (CES-D = 21.6) and had an extremely negative quality of life (ADDQoL = - 1.58). We believe that enhanced NCM will both improve self-care and reduce emotional distress for patients with diabetes. If proven effective, enhanced NCM may be translated to other chronic illnesses.",
author = "Heather Stuckey and Cheryl Dellasega and Graber, {Nora J.} and David Mauger and Irina Lendel and Gabbay, {Robert A.}",
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T2 - Study design and baseline characteristics in the Chronic Care Model for type 2 diabetes

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AU - Dellasega, Cheryl

AU - Graber, Nora J.

AU - Mauger, David

AU - Lendel, Irina

AU - Gabbay, Robert A.

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N2 - Background: Despite evidence that diabetes is costly and devastating, the health care system is poorly equipped to meet the challenges of chronic disease care. The Penn State Institute of Diabetes & Obesity is evaluating a model of managing type 2 DM which includes nurse case management (NCM) and motivational interviewing (MI) to foster behavior change. The primary care intervention is designed to improve patients' self care and to reduce clinical inertia through provider use of standardized clinical guidelines to achieve better diabetes outcomes. Methods: This RCT tests the efficacy of an enhanced NCM intervention on type 2 DM (n = 549) patient outcomes mediated by changes in self-care behavior and diabetes management. Outcome measures include: (a) effect on clinical parameters such as HbA1c (< 7), BP (< 130/80), and LDL (< 100), depression scores and weight; (b) process measures such as complication screening; (c) patient psychological and behavioral outcomes as measured by emotional distress (PAID), diabetes-specific quality of life (ADDQoL), patient satisfaction (DTSQ), self-care activities (SDSCA); and (d) physician satisfaction and cost-effectiveness of the intervention. Conclusions: Baseline includes (mean) age = 58; BMI = 34.4; 57% females; 47% Caucasian, and 39% Hispanic. Patients had elevated HbA1c (8.4), BP (137/77) and LDL (114). Overall, patients were depressed (CES-D = 21.6) and had an extremely negative quality of life (ADDQoL = - 1.58). We believe that enhanced NCM will both improve self-care and reduce emotional distress for patients with diabetes. If proven effective, enhanced NCM may be translated to other chronic illnesses.

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