The Impact of a Diabetes Transitions of Care Clinic on Hospital Utilization and Patient Care

Abstract

Background There is currently limited guidance from the American Diabetes Association regarding transitions of care for patients with diabetes. Objective This study’s aim was to determine the impact of a diabetes-specific transitions of care clinic (TOCC) on hospital utilization and patient outcomes in recently discharged patients with diabetes. Methods This retrospective study evaluated patients seen by TOCC as compared with similar patients discharged from the study institution the year prior. The primary outcome was a composite of the number of unique patients with readmissions/emergency department (ED) visits within 30 days of discharge. Secondary outcomes included a subcomponent analysis of readmissions/ED visits, index hospital length of stay (LOS), and to describe clinical interventions made in clinic. This study was approved by the institutional review board of the Office of Responsible Research Practice at the Ohio State University Wexner Medical Center. Results There were 165 patients in the TOCC group and 157 in the control group based on the matching criteria. There was a statistically significant decrease in the primary outcome in the TOCC group versus the control group (18% vs 36%, P < 0.001). In evaluation of its subcomponents, there was a statically significant decrease in patients with readmissions (11% vs 26%, P < 0.001) but not ED visits (10% vs 17%, P = 0.096). The LOS for the TOCC group was shorter at 4 days versus 5 days in the control group ( P = 0.055). Conclusions and Relevance The implementation of a diabetes-specific TOCC can decrease both readmissions and ED visits and may impact hospital LOS. In addition, a TOCC can be used to identify gaps in preventive care. The results from this study may help support the creation of similar TOCC at other institutions.

Evaluation of a Pharmacist-Managed Diabetes Transitions of Care Medication Management Clinic

“…As previously discussed, although this study did not show a change in readmission rates, current literature supports the use of a pharmacist integrated within a TOC service in reducing readmission to the hospital. Rinaldi et al 8 found that an interprofessional diabetes-focused TOC clinic, including an ambulatory care pharmacist, was effective in decreasing hospital utilization within 30 days of discharge.…”

“…Rinaldi et al 8 demonstrated the effectiveness of a diabetes TOC clinic service on hospital utilization. They evaluated a model in which patients with a diagnosis of diabetes discharged were eligible for referral to the diabetes TOC clinic, regardless of their reason for admission.…”

16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023

“…Individuals may be discharged to varied settings, including home (with or without visiting nurse services), assisted living, rehabilitation, or skilled nursing facilities. For individuals discharged to home or assisted living, the optimal discharge plan will need to consider diabetes type and severity, effects of the illness on blood glucose levels, and the individual's capabilities and preferences (29,152,153). See Section 13, "Older Adults," for more information.…”