1063. Disease-Management and Educational Intervention Outcomes in High-Risk Diabetics
Douglas Bradham, DrPH, Baltimore VAMHCS and CSP CC PP, Perry Point, WJ Culpepper, Baltimore VAMHCS, D Mann, Baltimore VAMHCS, KD Flannery, Baltimore VAMHCS, LR MacClellan, Baltimore VAMHCS, C Sadler, Baltimore VAMHCS, M Mangan, Baltimore VAMHCS, W Annette, Baltimore VAMHCS, E Murray, Martinsburg VAMC, M Agarwal, Washington DC VAMC, B Hamilton, Baltimore VAMHCS

Objectives: To examine whether interventions of diabetes self-management education programs with or without APN case managers improve outcomes and are cost effective.

Methods: Patients were randomly assigned to one of four groups: 1) APN case-management and diabetes education, 2) APN case-management alone, 3) Diabetes education alone and 4) Routine Care. Veterans receiving primary care in VISN-5 and meeting high-risk criteria (HbA1c ³ 9.0%) were screened for inclusion. Patient outcome measures were collected at baseline, three months and twelve months. These included: Quality of Life (QOL), HgbAlc levels, and incidence of diabetes-related hospitalizations/ER visits. In addition, patient-level intervention cost, health care use and costs were examined. ANOVA comparisons were used to test hypotheses.

Results: From 1999 through 2002, 708 patients were randomized to the four groups; 526 remained in the study for at least three months and 233 completed twelve months. HgbA1c was extracted from the VISTA database for 353 (of the 526) patients at each of the three time points. Overall, HgbA1c was significantly (p<0.05) reduced at one-year follow-up for all four patient groups (-1.28, -1.43, -0.88, -0.76, respectively). There was no difference between the APN case management groups (1 and 2) and there was no difference between the education alone and routine care groups (3 and 4). However, the APN case-management groups (1 and 2) had significantly lower HgbA1c compared to the education alone and routine care groups (3 and 4) at three and 12 months follow-up. All groups showed a similar pattern with the largest improvement observed at 3-months and then increasing slightly by the 1-year follow-up. Changes in QOL and preliminary expenditure analyses showed no significant differences between intervened and routine care groups.

Conclusions: The trial was completed in December 2002 and final analyses are underway.

Impact: The study’s impact on change in A1c is significantly greater in the intervention groups that received APN case-management than in the education only and usual care groups at three and twelve months. No intervention impact was detected in the OOL measure. The American Diabetes Association awarded National Recognition to the Diabetes Self-Management Education component of this grant for meeting evidence-based standards in clinical practice.