Synergy to Reduce Emergency Department Visits for Uncontrolled Hyperglycemia

Magee, Michelle F.; Nassar, Carine M.; Copeland, James; Fokar, Ali; Sharretts, John M.; Dubin, J.; Smith, Mark S.

doi:10.1177/0145721713484593

Cited by 15 publications

(26 citation statements)

References 14 publications

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“…In the context of U.S. health care reform and the formation of medical homes in networks of integrated medical and behavioral health services, EMS is well positioned for identifying and facilitating the access of vulnerable, high‐cost service users to and optimal engagement in health services . The findings call for interventions to promote the coordination and integration of EMS delivery with comprehensive, community‐based health services networks for contributing to goals of improved health outcomes and reduced health care costs . Our findings suggest that for Baltimore, public health intervention is especially indicated for enhancing the medical and self‐management of this frequent EMS‐using population's mental illness, substance abuse, diabetes, asthma, HIV, and other chronic conditions.…”

Section: Discussionmentioning

confidence: 89%

“…While ED data have greater validity, they are not available on a geographically defined population level and are incomplete in national ED reporting systems. For example, data from the U.S. Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network are subject to selection bias in the restriction to EDs in select geographic areas and low response rates of participating EDs . Data used in this study included information on EMS transports to over 20 area EDs located within 15 different hospitals…”

Section: Limitationsmentioning

confidence: 99%

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Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

et al. 2013

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Objectives To optimize healthcare utilization, health outcomes, and costs, research is needed to improve an understanding of frequent users of emergency health services. Frequent use of emergency services is associated with high costs of healthcare and may be indicative of challenges accessing, or poor outcomes of, healthcare. We identified patient demographics and health factors related to frequent use of the emergency medical services (EMS) system of a mid-sized city. Study findings will aid in the development of targeted interventions to improve population health. Methods We reviewed 9-1-1 call dispatch data and Baltimore City Fire Department EMS records in 2008–10. Frequent use was defined as six or more EMS incidents in the 23 month period. Analyses used census data to compare demographics of EMS users to their population distribution; and examined differences in demographics and health problems of frequent EMS users compared to non-frequent users. Results Frequent EMS users (n=1,969) had a range of 6–199 EMS incidents (mean 11.2) during the observation period; and though they accounted for only 1.5% of EMS users, they were involved in 12.0% of incidents. Frequent users, as compared to non-frequent users and to the population, were more likely to be male, African American, or 45 years or older. Of frequent users, the modal age group was 45–54 years, accounting for 29.7% of frequent users, which represented twice this age group’s population distribution. Furthermore, this age group had the greatest overrepresentation of males (63.0% of frequent users), and was the peak age group for substance abuse related incidents (28.0% of frequent users’ incidents in this age group). Frequent users compared to non-frequent users had lower levels of trauma related incidents (5.1% versus 16.7%) and higher levels of medical incidents (94.8% versus 82.9%). As proportions of EMS incidents among frequent versus non-frequent users, respiratory, mental health, and seizure related incidents were highest in the youngest age groups; and substance abuse related incidents were highest in those middle aged (35–44 years and 45–54 years). Of health problems, behavioral health (mental health or substance use) problems most contributed to frequent EMS use (23.4% of frequent users’ incidents). Across all incidents, 65.8% of frequent users had an indication of behavioral health problems, representing a 6.6-fold higher odds than non-frequent users (22.5%). Frequent compared to non-frequent users also had higher levels of select chronic conditions (diabetes: 39.9% vs. 14.6%, respectively; asthma: 40.9% vs. 13.4%; and HIV: 9.1% vs. 2.4%), with unadjusted odds almost 4 to 7 times higher. Conclusions The study findings revealed the major role of chronic somatic and behavioral health problems in frequent EMS use; and that rates of frequent use were highest among those middle aged, African American, and male. The results suggest the need for coordination of EMS with community-based, integrated medical and behavioral health services to impro...

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Section: Discussionmentioning

confidence: 89%

Section: Limitationsmentioning

confidence: 99%

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

et al. 2013

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“…The preplanned analyses presented in this article were conducted as part of a larger prospective randomized controlled study that enrolled patients to test the efficacy of a 3-component intervention that delivered guideline-based diabetes medication management, support for health system navigation, and survival-skills DSME. 23 The data for the 51 patients randomly assigned to the intervention group in the study are included in this analysis. Therefore, the study design reported in this article is a 1-group pretest–posttest design comparing knowledge and skills between intervention group patients’ baseline ED visit and their 24- to 72-hour post-ED discharge follow-up visit.…”

Section: Methodsmentioning

confidence: 99%

“…Diabetes medications were then initiated and/or modified based on the study’s antihyperglycemic medication algorithm. 23…”

Section: Methodsmentioning

confidence: 99%

Successful Patient Diabetes Education in the Emergency Department

et al. 2015

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“…Inpatient diabetes education is intended to deliver the critical survival skills required for safe self-care during the transition from the hospital to the ambulatory setting (Powers et al, 2015). To address the need for sustainable diabetes survival skills education (DSSE) for use in both inpatient and ambulatory settings, we have developed Diabetes to Go (D2Go), a DSSE program that assesses individual diabetes knowledge gaps and links those gaps to educational content (Lewis, Benda, Nassar, & Magee, 2015;Magee et al, 2013;Magee, Khan, Desale, & Nassar, 2014). D2Go has demonstrated effectiveness when provided to general medicine and surgery inpatients and in outpatient settings when delivered in a research context by a study team (Magee et al, 2013;Magee et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Diabetes Education for Behavioral Health Inpatients: Challenges and Opportunities

Bardsley

Baker²,

Smith

et al. 2019

J Am Psychiatr Nurses Assoc

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OBJECTIVE: To adapt a diabetes survival skills education (DSSE) program for delivery on inpatient behavioral health units (BHUs) and to evaluate implementation feasibility within nursing unit workflow. METHODS: We employed mixed methods to codesign, implement, and evaluate a DSSE program for inpatient BHUs. The Diabetes to Go core program incorporates linking knowledge deficits to video education content, a companion book on diabetes survival skills, and education for nurses on delivery processes and teaching content. The Diabetes to Go adaptation for BHUs was codesigned in partnership with BHU staff and patients. Implementation evaluation included patient surveys and nursing staff feedback obtained during field observations. RESULTS: A total of 89 patients participated in nine group education sessions among whom 17 (20%) had diabetes. Nursing unit staff and patients expressed willingness to engage in program design. Barriers to implementation were encountered in both groups including lack of standardization of education content by nurse facilitators and difficulty engaging patients for the time required for completion of surveys plus group education. Preferred education media for both nurses and patients was a book. Diabetes knowledge deficits were identified among over two thirds of participants with diabetes. CONCLUSIONS: Group class may not be the optimal delivery model for specialized DSSE on BHUs. It remains to be determined if individual diabetes education alone or a model which combines individual and group sessions is preferable. Translation of standardized approaches for diabetes education on inpatient BHUs will require further redesign to meet the unique needs of this population.

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Synergy to Reduce Emergency Department Visits for Uncontrolled Hyperglycemia

Abstract: Diabetes medication management and survival skills education for uncontrolled diabetes may be safely initiated in the ED, as demonstrated by the multidisciplinary STEP-DC intervention, which effectively enabled glycemic control in this pilot study.

Cited by 15 publications

References 14 publications

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

Successful Patient Diabetes Education in the Emergency Department

Diabetes Education for Behavioral Health Inpatients: Challenges and Opportunities

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