Studies have demonstrated that intensive disease management of diabetes and its associated risk factors, hypertension and dyslipidemia, can prevent the progression of vascular complications. However, implementation of well defined guidelines for intensive disease management has been suboptimal. Barriers to success occur at multiple levels, including health care systems, health care providers and patients. In rural regions of the U.S., reduced availability of primary care providers and specialty services, including diabetes education, present additional barriers to effective diabetes care. Use of a nurse practitioner led interdisciplinary team to intensively manage urban and rural diabetic patients, utilizing telehealth technology to provide care to rural areas, will help begin to address these barriers The long term goal of the project is to develop a practical and sustainable system of intensive diabetes management that will be effective in helping diabetic patients achieve and maintain goals within established treatment guidelines regardless of geographic location.
Specific aims are: 1.To determine in both urban and rural areas if a nurse practitioner led team approach to intensive diabetes management and education improves disease-specific outcomes and patient education compared to traditional care (current diabetes management of urban patients). 2. To determine if telehealth is an effective and accepted mechanism for delivery of a nurse practitioner led team approach to intensive diabetes management and education in rural areas. 3. To determine if a nurse practitioner led intensive disease management team can identify patient risk factors (psychological, financial, and work-related factors), that may be barriers to patient adherence, earlier in the management of urban diabetic patients compared to traditional care. 4.To determine health service utilization associated with a nurse practitioner led team approach to diabetes management and education in rural and urban areas compared to that of traditional care. Disease-specific outcomes will include physiologic variables (HbA1c, blood pressure, lipid levels), measurement and documentation of preventive services (dilated eye exam, monofilament exam, microalbumin testing) and patient's knowledge of disease tested by questionnaire. Results should show improved outcomes and patient knowledge in urban and rural patients receiving intensive disease management compared to traditional care.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
1R18DK065787-01A1
Application #
6822319
Study Section
Special Emphasis Panel (ZDK1-GRB-1 (M2))
Program Officer
Staten, Myrlene A
Project Start
2004-09-01
Project End
2008-07-31
Budget Start
2004-09-01
Budget End
2005-07-31
Support Year
1
Fiscal Year
2004
Total Cost
$545,193
Indirect Cost
Name
Billings Clinic Foundation
Department
Type
DUNS #
142115984
City
Billings
State
MT
Country
United States
Zip Code
59101