Effect of nurse-directed XXXX care in a minority population.

@entity1 @entity6
OBJECTIVE: To determine whether @entity6 care directed by nurses following detailed protocols and algorithms and supervised by a diabetologist results in meeting the evidence-based American @entity6 Association (ADA) process and outcome measures more often than care directed under usual care in a minority population. RESEARCH DESIGN AND METHODS: Studies were mainly conducted in two Los Angeles County clinics. In clinic A, nurse-directed @entity6 care was provided to 252 @entity1 (92% Hispanic and 2% African-American) referred by their primary care providers. These @entity1 were hierarchically matched with 252 @entity6 @entity1 in clinic B (79% Hispanic and 19% African American). When nurse-directed care was abruptly discontinued in clinic A for administrative reasons, it was reestablished in clinic B. Those @entity1 were randomly selected from a teaching clinic, and the outcomes in 114 @entity1 who completed 1 year were compared with outcomes derived the year before receiving nurses' care. The following process and outcome measures were assessed in the study: 1) number of visits, 2) @entity6 education, 3) nutritional counseling, 4) HbA(1c), 5) lipid profiles, 6) eye exams, 7) foot exams, 8) renal evaluations, and 9) ACE inhibitor therapy in appropriate @entity1 . RESULTS: For @entity1 under nurse-directed @entity6 care in both clinics A and B, almost all process measures were carried out significantly more frequently than for the appropriate control @entity1 . Under the care of nurses in clinic A, HbA(1c) levels fell 3.5% from 13.3 to 9.8% in the 120 @entity1 who were followed for at least 6 months, as compared with a 1.5% fall from 12.3 to 10.8% under usual (physician-directed) care in clinic B. During the year before enrolling in nurse-directed care in clinic B, mean HbA(1c) levels decreased from 10.0 to 8.5%. At the end of a year under the nurses' care, the values fell further to 7.1%. The median value fell from 8.3 to 6.6%. CONCLUSIONS: Specially trained nurses who follow detailed protocols and algorithms under the supervision of a diabetologist can markedly improve @entity6 outcomes in a minority population. This approach could help blunt the increased morbidity and mortality noted in minority populations.
