The objective of this study was to evaluate the value of an intensive telephone follow-up as an additional component of a diabetes disease management program already shown to be effective in improving glycemic control, adherence with American Diabetes Association (ADA) standards of care, and health-related quality of life (HRQOL). The study involved a randomized controlled trial. The intervention group received a series of 12 weekly phone calls reinforcing base education and self-management skills. Five hundred and seven consenting patients, age 18 years or older, with type 1 or type 2 diabetes mellitus referred to the hospital- based disease management program who had telephones and were able to complete surveys in English or Spanish were enrolled. Outcomes were evaluated at 3 and 12 months follow- up. Adherence to ADA standards of care, specifically annual eye exams, physician foot exams, foot self-exams, and pneumonia vaccination were significantly better with the added telephone intervention, but there were no differences between the groups on glycemic control, HRQOL, or patient satisfaction. The effectiveness of the disease management program was replicated with sustained improvement in glycemic control, HRQOL, and adherence to ADA standards. The additional telephone intervention further improved adherence to ADA guidelines for self-care and medical care but did not affect glycemic control or HRQOL.

Objective: Hospitalized patient falls are a major cause of disability, functional impairment, and even death. The objective of this prospective study was to assess the frequency and contributing factors of falls in hospitalized patients. Methods: Between December 2004 and November 2005, data related to falls in hospitalized patients were recorded: patient demographics, the patient's functionality, mental status, surrounding circumstances, and the level of injury. Outcome measures were overall rates of patient falls as a function of ward, shift, month, age, and incidence rate ratios (IRRs). Results: Falls were recorded in 611 patients. The overall patient fall rate was 4.36 (95% confidence interval, 4.02 to 4.72) per 1000 patient-days. The fall rate was significantly above the mean for the neurosurgical (IRR = 2.32; P G 0.001) and short-stay wards (IRR = 1.69; P = 0.013). Patients aged 56 to 70 years or older than 70 years fell 1.45 and 1.78 times more frequently, respectively, versus patients aged 55 years or younger (P G 0.001). The odds that a fall resulted in injury were multiplied by 1.19 for each additional decade of age (P = 0.018), and the age-adjusted injury rate for the oncology ward (46.4%) was significantly higher than the overall average (P = 0.001). Conclusions: Age and the patient condition before and during hospitalization resulted as the most important determinants of falls in hospitalized patients.