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|Issue 72||November 2013|
A Systematic Review: Effects of Nurse-Managed Protocols in the Outpatient Management of Adults with Chronic Conditions
Medical management of chronic illness consumes 75% of every healthcare dollar spent in the United States; thus, the provision of economical and accessible, yet high-quality care is a major concern. Diabetes, hypertension, hyperlipidemia, and cardiovascular disease are prime examples of chronic diseases that cause substantial morbidity and mortality, and require long-term medical management. VA is developing protocols and policies that expand the nurse's role as a member of Patient Aligned Care Teams (PACTs) as one strategy to address the need to improve the management of these chronic illnesses. A protocol includes a series of actions set by current clinical guidelines or standards of practice that are implemented by nurses to manage a patient's condition.
The VA Evidence-Based Synthesis Program located in Durham, NC conducted a systematic review of the literature to describe the effects of nurse-managed protocols for the outpatient management of adults with high-impact, chronic conditions, such as type 2 diabetes, hypertension, hyperlipidemia, and congestive heart failure (CHF). Investigators conducted a review of the literature from January 1, 1980 through December 12, 2012 for peer-reviewed publications that evaluated interventions using nurse-managed protocols compared with usual care in studies targeting adults with the aforementioned conditions. This evidence report is based on 31 articles, reporting on 29 unique studies (26 were randomized controlled trials). Results are presented in the Summary, which is followed by three key questions that provide more detailed information.
Key Question #1
Moreover, subgroup analyses showed some differences between in-person and telephone-based care studies. For example, interventions delivered primarily by telephone showed significantly greater effects for total and LDL cholesterol in patients with elevated cardiovascular risk, and greater mortality reductions in patients with CHF.
Key Question #2
Key Question #3
Only one fair-quality U.S. study on diabetes in a health maintenance organization reported on adverse events. Severe low blood glucose events were identical (1.5%) at baseline and increased similarly: 2.9% in the control group compared with 3.1% in the intervention group.
A Cyberseminar session on this ESP Report will be held on Tuesday, January 28, 2014 from 11:00am to 12:15pm (ET). View archived session here.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers — and to disseminate these reports throughout VA.
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This Management eBrief is a product of the HSR&D Evidence Synthesis Program (ESP). ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers - and to disseminate these reports throughout VA.
See all reports online.