Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost

Bansal, Vivek; Mottalib, Adham; Pawar, Taranveer K; Abbasakoor, Noormuhammad; Chuang, Eunice; Chaudhry, Abrar; Sakr, Mahmoud; Gabbay, Robert A.; Hamdy, Osama

doi:10.1136/bmjdrc-2017-000460

Cited by 68 publications

(63 citation statements)

References 18 publications

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“…The impact of diabetes inpatient teams on readmission rates has been evaluated in studies, with differing outcomes reported . One such study found reduced 30‐day readmissions in people admitted to medical services, while readmissions to surgical services increased ; in the present study, only a relatively small proportion of the inpatients with diabetes was included in the intervention, in contrast to the present study, which impacted the whole diabetes inpatient population and additionally factored in the changes in the length of stay and readmissions of those without diabetes into the analyses.…”

Section: Discussionmentioning

confidence: 68%

Impact of the Diabetes Inpatient Care and Education (DICE) project on length of stay and mortality

et al. 2019

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AimTo determine whether the Diabetes Inpatient Care and Education (DICE) programme, a whole-systems approach to managing inpatient diabetes, reduces length of stay, in-hospital mortality and readmissions.Research design and methods Diabetes Inpatient Care and Education initiatives included identification of all diabetes admissions, a novel DICE care-pathway, an online system for prioritizing referrals, use of web-linked glucose meters, an enhanced diabetes team, and novel diabetes training for doctors. Patient administration system data were extracted for people admitted to Ipswich Hospital from January 2008 to June 2016. Logistic regression was used to compare binary outcomes (mortality, 30-day readmissions) 6 months before and after the intervention; generalized estimating equations were used to compare lengths of stay. Interrupted time series analysis was performed over the full 7.5-year period to account for secular trends.Results Before-and-after analysis revealed a significant reduction in lengths of stay for people with and without diabetes: relative ratios 0.89 (95% CI 0.83, 0.97) and 0.93 (95% CI 0.90, 0.96), respectively; however, in interrupted time series analysis the change in long-term trend for length of stay following the intervention was significant only for people with diabetes (P=0.017 vs P=0.48). Odds ratios for mortality were 0.63 (0.48, 0.82) and 0.81 (0.70, 0.93) in people with and without diabetes, respectively; however, the change in trend was not significant in people with diabetes, while there was an apparent increase in those without diabetes. There was no significant change in 30-day readmissions, but interrupted time series analysis showed a rising trend in both groups. ConclusionThe DICE programme was associated with a shorter length of stay in inpatients with diabetes beyond that observed in people without diabetes.

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Section: Discussionmentioning

confidence: 68%

Impact of the Diabetes Inpatient Care and Education (DICE) project on length of stay and mortality

et al. 2019

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“…4) Others using teams of caregivers have achieved a reduction in 30-day all-cause readmissions of 30 percent. [14] In our diabetic patients with Grand-Aides, hospital readmissions were significantly reduced by 50 percent.…”

Section: Discussionmentioning

confidence: 70%

Management of patients with type 2 diabetes mellitus in the Grand-Aides Program

Bednar

Donowitz²,

Oliver³

2019

JNEP

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Objective: To evaluate the Grand-Aides Program for patients with type 2 diabetes mellitus (T2DM) according to the variables of body weight, blood pressure, medication adherence, and hospital consultation and readmissions.Methods: Patients ages 18 years or older with a past medical history of T2DM, hypertension (HTN), and/or obesity and who were recently seen in the emergency department (ED) or recently admitted to the hospital were eligible to enroll in the Grand-Aides Program. Eligible patients were identified after hospital or ED discharge and were asked to enroll in the in-home based program from March 2016 through June 2018. In-home visit protocol was defined prior to patient enrollment with intense in-home visits during the first weeks of enrollment followed by monthly visits for the duration of enrollment in the program. In-home visit frequency was adjusted on as needed basis so that patients at higher risk for ED visits or hospitalization were seen more frequently. In-home visits were performed by trained Grand-Aide who for the purpose of this study was a certified nursing assistant (CNA). The Grand-Aide underwent eighty hours of didactic training which included visit protocols, visit schedules, and data collection. The one-on-one in-home patient with every visit were supervised by a registered nurse (RN) or nurse practitioner (NP) via video or telephone contact near the conclusion of the visit. Active patients at the University of Virginia Family Medicine clinic were eligible for enrollment. Fifty-seven patients with T2DM worked with Grand-Aides for three months and an additional forty-eight T2DM patients worked with Grand-Aides for twelve months. Emergency department visits, all 30-day hospital readmissions, as well as blood pressure readings, medication adherence, weights, and glycated hemoglobin (HbA1c) were compared with the prior twelve months.Results: Systolic (p < .001) and diastolic (p < .01) blood pressures decreased (p < .01) at 1 year. At baseline 56 percent of the patients had a systolic blood pressure of >130 mmHg despite treatment; after 12 months, 48 percent of these were < 130. In those whose baseline diastolic blood pressure was > 90 mmHg, 100 percent had diastolic blood pressure < 90 mmHg at 1 year. Medication adherence by ARMS test at 1 year was 94 percent. Despite trending downward, weight and HbA1c did not change significantly. In the preceding, 58 percent had at least one ED visit, which was reduced by 50 percent (p < .01) with Grand-Aides; 30-day all-cause readmissions reduced by 50 percent to 6.3 percent. Conclusions: The Grand-Aides program was associated with a significant change in blood pressure control, high medication adherence and reductions in ED visits and readmissions that compare favorably with published comparative data. For systems “at risk” for preventable increased health care expense burden, the Grand-Aides program can result in significant savings.

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“…This could be explained by a number of reasons: primarily, the interventions that a DISN is able to provide, as well as the outpatient follow‐up and telephone contact provided by DISNs after discharge, prevented the need for further hospitalisation. Studies have shown that patient education performed by a specialised team, specifically diabetes specialist nurses, decreases readmission rates by improving patient adherence to treatment and improving glycaemic control, even after the patient has been discharged . Improved self‐management can make the transition after discharge easier for patients and improve the chances of a normal recovery without the need for further hospital intervention .…”

Section: Discussionmentioning

confidence: 99%

“…Interventions provided by DISNs typically include monitoring blood glucose, managing medication and providing support and advice to both the patient and the primary care team, with a strong emphasis on education . Point‐of‐care testing (POCT) is used by DISNs to enable clinical decisions to be made at the time of assessment, allowing fast diagnosis, monitoring and treatment . Studies have reported that POCT is associated with improved patient satisfaction and better glycaemic control .…”

Section: Introductionmentioning

confidence: 99%

Diabetes specialist nurse point‐of‐care review service: improving clinical outcomes for people with diabetes on emergency wards

et al. 2020

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It is well established that inpatients with diabetes are associated with poorer clinical outcomes. We therefore investigated the effects of introducing a point‐of‐care (POC) ward‐based glucose and ketones assessment to trigger a diabetes inpatient specialist nurse (DISN) proactive review to the ward, on the length of stay (LOS), 30‐day readmission rate and 30‐day mortality rate. Data were extracted for patients admitted to The Royal Derby Hospital during two six‐month periods in 2017 (pre‐intervention) and 2018 (post‐intervention). Data from four acute wards were used in the analysis, including two high dependency units (HDUs), an intensive care unit (ICU) and a medical admissions unit. The following clinical outcome measures were compared between the two groups: average LOS, 30‐day readmission rate and 30‐day mortality rate. Subgroup analysis was also performed to investigate the clinical outcomes for insulin‐treated patients. In total, 979 patient admissions were included in the study (n=443 in the 2017 pre‐intervention; n=536 in the 2018 post‐intervention). Thirty‐day readmission rates decreased significantly after the introduction of the POC‐DISN proactive review (29.3% to 20.1%, p=0.001). However, 30‐day mortality rates and the average LOS did not significantly decrease. Subgroup analysis showed that 30‐day readmission rates among the three wards (ICU and two HDUs) reduced further for patients using insulin (26.8% to 16.4%, p<0.05) compared to those not using insulin (26.6% to 22.2%, p<0.05). In conclusion, POC‐DISN intervention was effective in reducing 30‐day readmission rates for inpatients with diabetes. There was no significant impact on the 30‐day mortality rate or average LOS. Patients using insulin as part of their diabetes management were more likely to benefit from this intervention. Copyright © 2020 John Wiley & Sons.

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Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost

Cited by 68 publications

References 18 publications

Impact of the Diabetes Inpatient Care and Education (DICE) project on length of stay and mortality

Impact of the Diabetes Inpatient Care and Education (DICE) project on length of stay and mortality

Management of patients with type 2 diabetes mellitus in the Grand-Aides Program

Diabetes specialist nurse point‐of‐care review service: improving clinical outcomes for people with diabetes on emergency wards

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