Exploring the Cost and Clinical Outcomes of Integrating the Registered Nurse-Certified Diabetes Educator in the PCMH

Burson, Rosanne, and Kathy Moran

Problem: It is estimated that by the year 2020, 52% of the adult population will have diabetes/pre-diabetes, with an annual cost of $500 billion; about 10% of health care spending.1 It is evident new models of care need to be introduced that provide successful clinical outcomes within a cost-effective venue. This study implemented/evaluated a care delivery model integrating the registered nurse-certified diabetes educator (RN-CDE) in the Patient-Centered Medical Home (PCMH) to meet the unique needs of this population.

Literature Review: PCMH is a delivery system redesign that includes self-management education that has a positive influence on practices and patient outcomes.2 Diabetes education empowers the patient to utilize self-management skills that lead to reduced medical costs and positive clinical outcomes (average blood glucose, low-density cholesterol, fasting blood glucose).3-4

Methods: Thirty-four patients were recruited from two primary care offices. The intervention incorporated group and individual sessions over 14 weeks. Study measures were compared before and after the intervention, focusing on attainment of positive clinical outcomes and cost-benefit analysis. Surveys also investigated changes in the participant’s perception of their ability to self-manage their diabetes.

Results: Comparison tests identified significant improvements in the psychological components of self-management as well as average blood glucose and aspects of cholesterol control. Cost-benefit analysis revealed a net program benefit.

Conclusion/Relevance: Integrating the RN-CDE in the PCMH improves clinical outcomes and is cost-effective. It is critical with today’s limited resources that effective, appropriate providers and tools are used to assist patients to reach clinical outcomes.