An interprofessional collaboration of care to improve clinical outcomes for patients with diabetes

ABSTRACT

This project addressed interprofessional team-based care to improve management and outcomes of complex patients with diabetes. A collaborative model between Family Medicine and Nursing was developed to determine if having nursing students as case managers would improve the quality of care. From 2015–2016, patients with diabetes at greatest risk for poor outcomes (N = 58) received an intervention from senior nursing students (N = 6) at a Family Practice Center. Nursing students shared responsibilities with physicians, medical students, and medical assistants to deliver high quality care. For the intervention, nursing students reviewed charts, called patients for follow-up visits, and facilitated patients’ adherence to providers’ recommendations. Students also conducted group education sessions on nutrition, medication adherence, obesity, and exercise for patients. The control group included 61 randomly selected patients with diabetes who did not receive the intervention during the same period of time. Compared to the control group, the intervention group showed significantly improved outcomes in HgA1C levels (66% vs. 40.8%; p = .009), blood pressure control (61.1% vs. 36.8%; p = .009), and urine microalbumin test completion (87.5% vs. 48.3%; p<  .0001). Outpatient practices offer an optimal opportunity for nursing students to practice case management. This team-based care approach suggests better outcomes for patients with diabetes.

KEYWORDS:

• Diabetes
• nursing
• inter-professional
• family medicine

Acknowledgments

The authors would like to thank Chantal Brazeau, MD, Jacklyn Johnson, Nia Joseph, Eric Pan, Diana Paneque, Chelsea Agbay, Ali Greulich, Harrison Chiu, and Megan Pan for their assistance in the preparation of the manuscript.

Additional information

Notes on contributors

Maritza De La Rosa

Maritza De La Rosa, MD, has over 30 years of experience in clinical primary care, Family Medicine and have worked in a variety of clinical settings spanning the northeastern United States, as well as in Puerto Rico. Her research and presentations have focused on primary care; specifically, diabetes care, the development and dissemination of care teams, using the patient centered care team model, and the role of interprofessional collaborations in primary care.

Shelby Pitts

Shelby Pitts, DNP, RN, WHNP-BC has received a Bachelor of Science in Nursing (BSN) from Temple University College of Nursing, Master of Science in Nursing (MSN) from Rutgers University School of Nursing and Doctor of Nursing Practice (DNP) from Johns Hopkins University School of Nursing. In addition to her academic appointment, Dr. Pitts practices as a board-certified Women’s Health Advance Practice Nurse and serves as a mentor and preceptor for nursing students during their clinical rotations. Dr. Pitts’ scholarship focus has been on community health nursing, gestational diabetes mellitus and maternal morbidity and mortality among minority populations.

Ping-Hsin Chen

Ping-Hsin Chen, PhD, has over 15 years of extensive experience in medical research and education. Her areas of expertise include, but are not limited to, clinical research, provider training and patient education, community intervention programs (particularly on violence and injury), and research methodology. She has also been a Principal Investigator and a Co-Principal Investigator on several NIH-funded and foundation-funded studies.