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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities

TitleCost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities
Publication TypeJournal Article
Year of Publication2014
AuthorsAllen, JK, Dennison Himmelfarb, CR, Szanton, SL, Frick, KD
JournalJournal of Cardiovascular Nursing
Volume29
Pagination308-14
Date PublishedJul
ISBN Number0889-4655
Accession Number23635809
Keywords*Healthcare Disparities, Adult, Aged, Cardiovascular Diseases/*economics/*nursing, Cardiovascular Nursing/*organization & administration, Community Health Services/*economics, Community Health Workers/*organization & administration, community-based participatory research, Diabetes Mellitus, Type 2/economics/nursing, Female, Humans, Hypercholesterolemia/economics/nursing, Hypertension/economics/nursing, Male, Middle Aged
Abstract

BACKGROUND: Although evidence-based guidelines on the management of cardiovascular disease (CVD) and type 2 diabetes have been widely published, implementation of recommended therapies is suboptimal. OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of a comprehensive program of CVD risk reduction delivered by nurse practitioner/community health worker (NP/CHW) teams versus enhanced usual care to improve lipids, blood pressure (BP), and hemoglobin (Hb) A1c levels in patients in urban community health centers. METHODS: A total of 525 patients with documented CVD, type 2 diabetes, hypercholesterolemia, or hypertension and levels of low-density lipoprotein cholesterol, BP, or Hb A1c that exceeded goals established by national guidelines were randomized to NP/CHW (n = 261) or enhanced usual care (n = 264) groups. Cost-effectiveness ratios were calculated, determining costs per percent and unit change in the primary outcomes. RESULTS: The mean incremental total cost per patient (NP/CHW and physician) was only $627 (confidence interval, 248-1015). The cost-effectiveness of the 1-year intervention was $157 for every 1% drop in systolic BP and $190 for every 1% drop in diastolic BP, $149 per 1% drop in Hb A1c, and $40 per 1% drop in low-density lipoprotein cholesterol. CONCLUSIONS: The findings suggest that management by an NP/CHW team is a cost-effective approach for community health centers to consider in improving the care of patients with existing CVD or at high risk for the development of CVD.

PMCID

Pmc3766479