Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Abstract

Background: Hospitalized patients with diabetes are at risk of complications and longer length of stay (LOS). Inpatient Diabetes Management Services (IDMS) are known to be beneficial; however, their impact on patient care measures in community, non-teaching hospitals, is unknown. Objectives: To evaluate whether co-managing patients with diabetes by the IDMS team reduces LOS and 30-day readmission rate (30DR). Methods: This retrospective quality improvement cohort study analyzed LOS and 30DR among patients with diabetes admitted to a community hospital. The IDMS medical team consisted of an endocrinologist, nurse practitioner, and diabetes educator. The comparison group consisted of hospitalized patients with diabetes under standard care of attending physicians (mostly internal medicine-trained hospitalists). The relationship between study groups and outcome variables was assessed using Generalized Estimating Equation models. Results: 4,654 patients with diabetes (70.8 ± 0.2 years old) were admitted between January 2016 and May 2017. The IDMS team co-managed 18.3% of patients, mostly with higher severity of illness scores (p < 0.0001). Mean LOS in patients co-managed by the IDMS team decreased by 27%. Median LOS decreased over time in the IDMS group (p = 0.046), while no significant decrease was seen in the comparison group. Mean 30DR in patients comanaged by the IDMS decreased by 10.71%. Median 30DR decreased among patients comanaged by the IDMS (p = 0.048). Conclusions: In a community hospital setting, LOS and 30DR significantly decreased in patients co-managed by a specialized diabetes team. These changes may be translated into considerable cost savings.

Inpatient Diabetes Management During the COVID-19 Crisis: Experiences From Two Community Hospitals

“…9,10 Could inpatient diabetes telemedicine result in both improvements in quality of care and cost savings, as seen with the traditional approach? 4 This remains to be seen. Anecdotally, patients, hospitalists, and intensivists alike have been thankful to have IDMS input during this pandemic, particularly with difficult-to-control hyperglycemia or critically ill patients.…”

“…6 This treatment plan is offered to all patients with diabetes regardless of their reason of admission and has been shown to reduce patient length of stay and readmission rates. 4 During this pandemic, hospitals have been forced to modify many of their longstanding practices of inpatient care in the attempt to prevent the spread of this highly infectious disease to patients and care team, while also preserving valuable and scarce personal protective equipment (PPE). Inpatient telemedicine has rapidly increased in popularity and utilization since the beginning of the crisis as physicians seek to limit face-to-face patient interaction, yet still, maintain the engagement necessary to provide high-quality medical care.…”

“…Previously, we implemented an Inpatient Diabetes Management Service (IDMS) at two community hospitals within the Johns Hopkins Health System in Maryland, which has led to significant improvements in hyper- and hypoglycemia rates. 4,5 The IDMS, consisting of an endocrine hospitalist, nurse practitioner, and diabetes educator, develops a personalized diabetes care plan with the patient while admitted and on discharge, arranges for follow-up with a certified diabetes educator or remote patient monitoring nurse, and offers to connect the patient with endocrine specialists and other resources postdischarge for continued care. 6 This treatment plan is offered to all patients with diabetes regardless of their reason of admission and has been shown to reduce patient length of stay and readmission rates.…”

Diabetes and climate change

“…In a large study of 53,769 myocardial infarction admissions to public hospitals in Hong Kong from 2002 to 2011, scientists found an increased risk for admission during periods of both high and low temperatures [18]. Hospitalized patients with diabetes may require more hospitalizations per year and may have a longer length of stay [19].…”

Hospital Diabetes Meeting 2020

“…The Endocrine Hospitalist model has proven its worth in reducing lengths of stay, hospital readmissions, and inpatient hypoglycemia, and providing a significant return on investment. 40 , 41 Inpatient diabetes telehealth approach may be reasonable for some hospitalized patients with COVID-19 and dysglycemia. 42 The Endocrine Hospitalist model should guide other community hospitals in their endocrine and glucose management initiatives.…”