Date of Award

2003

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Nursing

First Advisor

Bennett, Mary

Abstract

The primary goal of this study was to determine the effectiveness of an evidence-based chronic disease management program at improving various health outcome indicators in diabetic patients in a rural Indiana community. A secondary data analysis was completed on data extracted from an electronic databases at the Clay City Center for Family Medicine (CCFMC). The health outcome indicators, glycosylated hemoglobin, urine microalbumin, blood pressure, and low-density lipoprotein data were taked from 49 patient records at various time points. Patient data from enrollment, 6 month, and 12-month time points were analyzed using paired t-tests and inferential statistics to determine the protocol's ability to facilitate improvements in health outcome indicators. Main outcome measures and results were as follows: 6 months after enrollment at CCFMC, those participants with available results (n=32) had a mean decrease in glycosylated hemoglobin from 8.38 to 7.71. The glycosylated hemoglobin levels for persons with data available at the 12-monty time point (n=35) decreased from 8.17 to 7.52. While these levels were not statistically significant, clinical relevance can be established. Six months after enrollment in the CCFMC disease management program persons with available data (n=14) had a mean reduction in LDL from 137.43 to 122.71 (p=.046). Twelve months after enrollment persons with data available (n=16) had a mean reduction in LDL from 134.19 to 107.13 (p<.001). Upon enrollment only 44.1% of persons had blood pressure under the ADA guideline of 130/80mmHg. At the 6-month time point, 48.0% of persons had blood pressure under the 130/80mmHg parameters. At the 12-month time point, 41.9% had diastolic pressures under 130/80mmHg. Analysis of completion rates revealed that urine microalbumin were recorded on 46.9% if subjects at either baseline time 1 or time 2. Of subjects in the study 83.7% had an LDL recorded. Glycosylated hemoglobin was documented in 95.9% of subjects in the study. A multitude of protocol adherence issues were noted in the process of evaluation. Our results show that, in the short term, chronic disease management protocols can result in improvements in health outcome indicators specific to diabetes.

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