Abstract 1249: Nurse Practitioner/Community Health Educator Intervention Improves the Quality of Chronic Care Management in Low-Income Patients
Chronic illness care in medically underserved patients with CVD or at high risk for CVD is complex. Prior research has demonstrated that patient-centered self-management support can improve care. The purpose of this study was to test the effectiveness of a nurse practitioner(NP)/community health educator(CHE) model of care in community health centers on improving patients’ perceptions of the quality of their chronic illness care. Patients with CVD, type 2 diabetes, hypertension, and/or hypercholesterolemia were randomized to receive a 1 year CVD risk management intervention including self-management from a NP/CHE team (I) or usual care (UC). The Patient Assessment of Chronic Illness Care (PACIC) instrument measured the outcome (possible score from 1–5). A total of 293 patients participated in the study (145 intervention, 148 usual care); mean age 55±12 years, 74% female, 91% Black; 67% graduated from high school, and 26% had an income < $10,000. Patients in the two groups did not differ significantly on baseline PACIC, sociodemographic or clinical characteristics. At baseline, patients in both groups rated the quality of their chronic illness care as low (I: mean score 1.66±0.99; UC mean score 2.27±1.09). PACIC changed significantly from baseline to one year in the intervention group on all of the 5 subscales showing the following mean increases: Patient Activation (1.38±1.41, p<0.0001); Delivery System Design (1.32±1.22, p<0.0001 ); Goal Setting (1.46±1.11, p<0.0001 ); Problem Solving (1.23±1.22, p<0.0001); Follow-up/Coordination (1.02±1.22, p<0.0001). There were no statistically significant changes in the total or subscale scores on the PACIC in the usual care group. In a general linear mixed model (adjusted for age, education, co-morbidities) participation in the NP/CHE intervention and having diagnosed CVD or diabetes were significantly associated with higher scores on the PACIC (t=−6.18, p<0.0001). The results of this study add to existing evidence that nurse-directed collaborative models of care can be effective approaches to improve patients’ perceptions of the quality of their care. Further study is needed to determine how this will translate into improved risk factor management and morbidity and mortality from CVD.