Date of Award

2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

Abstract

Diabetes is a lifelong debilitating and deadly chronic disease affecting nearly one out of every eleven Americans. This public health problem costs $245 billion annually in the United States. Long term research trials have shown that diabetes complications can be prevented with good glycemic control, but it is difficult for patients to maintain control without much support from their healthcare team. U.S. healthcare remains fragmented. With the passage of the Affordable Care Act, there are opportunities to redesign health care delivery to minimize fragmentation and improve patient outcomes. The aim of this study is to determine if a redesigned care delivery model of nurse-led interprofessional collaborative care-coordinated teams improved patient engagement, healthcare utilization and clinical indicators for adults with Type II diabetes. This was a retrospective, longitudinal, matched design using secondary data from one year prior to the intervention to one year post intervention. The study sample included two groups: 204 patients with Type 2 diabetes who were care coordinated in the redesigned primary care clinic and a matched sample of patients at the same health system receiving standard care. Dependent variables included patient engagement (missed visits, influenza immunizations, and annual eye examinations); healthcare utilization (number of hospitalizations, hospital days and emergency room visits); and clinical indicators (Hgb A1C, weight, systolic and diastolic blood pressure). Findings indicated a statistically significant improvement in Hgb A1C for both the pre/post data and the Intervention/Matched data, and a statistically significant improvement in weight change and diastolic blood pressure at goal (<90) for the pre/post intervention group. However, eye examinations was significantly better in the matched comparison group. There was no difference in healthcare utilization for either the pre/post intervention group or the intervention group in comparison to the propensity matched group.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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