Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities
Title | Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities |
Publication Type | Journal Article |
Year of Publication | 2014 |
Authors | Allen, JK, Dennison Himmelfarb, CR, Szanton, SL, Frick, KD |
Journal | Journal of Cardiovascular Nursing |
Volume | 29 |
Pagination | 308-14 |
Date Published | Jul |
ISBN Number | 0889-4655 |
Accession Number | 23635809 |
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 |