Skip to main content
Top

06-21-2018 | Inpatient diabetes | Review | Article

Strategies to Prevent Readmission in High-Risk Patients with Diabetes: the Importance of an Interdisciplinary Approach

Journal: Current Diabetes Reports

Authors: Naina Sinha Gregory, Jane J. Seley, Savira Kochhar Dargar, Naveen Galla, Linda M. Gerber, Jennifer I. Lee

Publisher: Springer US

Abstract

Purpose of Review

Patients with diabetes are known to have higher 30-day readmission rates compared to the general inpatient population. A number of strategies have been shown to be effective in lowering readmission rates.

Recent Findings

A review of the current literature revealed several strategies that have been associated with a decreased risk of readmission in high-risk patients with diabetes. These strategies include inpatient diabetes survival skills education and medication reconciliation prior to discharge to send the patient home with the “right” medications. Other key strategies include scheduling a follow-up phone call soon after discharge and an office visit to adjust the diabetes regimen. The authors identified the most successful strategies to reduce readmissions as well as some institutional barriers to following a transitional care program.

Summary

Recent studies have identified risk factors in the diabetes population that are associated with an increased risk of readmission as well as interventions to lower this risk. A standardized transitional care program that focuses on providing interventions while reducing barriers to implementation can contribute to a decreased risk of readmission.
Literature
1.
Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97:16–38.CrossRefPubMed
2.
American Diabetes Association. 14. Diabetes care in the hospital: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Suppl. 1):S144–51.CrossRef
3.
Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med. 2000;160(8):1074–81.CrossRefPubMed
4.
Kocher RP, Adashi EY. Hospital readmissions and the affordable care act: paying for coordinated quality care. JAMA. 2011;306(16):1794–5.CrossRefPubMed
5.
Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281(7):613–20.CrossRefPubMed
6.
Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822–8.CrossRefPubMed
7.
Voss R, Gardner R, Baier R, Butterfield K, Lehrman S, Gravenstein S. The care transitions intervention: translating from efficacy to effectiveness. Arch Intern Med. 2011;171(14):1232–7.CrossRefPubMed
8.
Pennsylvania Health Care Cost Containment Council. Hospital readmissions in Pennsylvania 2010. 2012;1–24.
9.
Friedman B, Jiang HJ, Elixhauser A. Costly hospital readmissions and complex chronic illness. Inquiry. 2008;45(4):408–21.CrossRefPubMed
10.
Kim H, Ross JS, Melkus GD, Zhao Z, Boockvar K. Scheduled and unscheduled hospital readmissions among patients with diabetes. Am J Manag Care. 2010;16(10):760–7.PubMedPubMedCentral
11.
Jiang HJ, Stryer D, Friedman B, Andrews R. Multiple hospitalizations for patients with diabetes. Diabetes Care. 2003;26(5):1421–6.CrossRefPubMed
12.
Petersen, M. Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033–46.
13.
Burke RE, Coleman EA. Interventions to decrease hospital readmissions: keys for cost-effectiveness. JAMA Intern Med. 2013;173(8):695–8.CrossRefPubMed
14.
Robbins JM, Webb DA. Diagnosing diabetes and preventing rehospitalizations: the urban diabetes study. Med Care. 2006;44(3):292–6.CrossRefPubMedPubMedCentral
15.
Ostling S, Wyckoff J, Ciarkowski SL, Pai CW, Choe HM, Bahl V, et al. The relationship between diabetes mellitus and 30-day readmission rates. Clin Diabetes Endocrinol. 2017;3(1):3.CrossRefPubMedPubMedCentral
16.
American Diabetes Association Scientific Statement. Economic cost of diabetes in the US in 2012. Diabetes Care. 2013;36:1033–46.CrossRef
17.
HCUP Nationwide Inpatient Sample (NIS) 2012. Agency for Healthcare Research and Quality. (AHRG). 2014. http://​www.​ahrq.​gov/​research/​data/​hcup/​index.​html.
18.
HCUP Nationwide Inpatient Sample (NIS) 2012. Agency for Healthcare Research and Quality. (AHRG). 2011. http://​www.​ahrq.​gov/​research/​data/​hcup/​index.​html.
19.
Albrecht JS, Hirshon JM, Goldberg R, Langenberg P, Day HR, Morgan DJ, et al. Serious mental illness and acute hospital readmission in diabetic patients. Am J Med Qual. 2012;27(6):503–8.CrossRefPubMedPubMedCentral
20.
Bennett KJ, Probst JC, Vyavaharkar M, Glover SH. Lower rehospitalization rates among rural Medicare beneficiaries with diabetes. J Rural Health. 2012;28(3):227–34.CrossRefPubMed
21.
Jiang HJ, Andrews R, Stryer D, Friedman B. Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes. Am J Public Health. 2005;95(9):1561–7.CrossRefPubMedPubMedCentral
22.
• Healy SJ, Black D, Harris C, Lorenz A, Dungan KM. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care. 2013;36(10):2960. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control–7.CrossRefPubMedPubMedCentral
23.
Rubin D, Handorf E, McDonnell M. Predicting early readmission risk among hospitalized patients with diabetes (7796). ENDO 2013: the Endocrine Society’s 95th Annual Meeting. 2013.
24.
Rubin D, McDonnell M, Nelson D, Zhao H, and Golden SH. Predicting hospital readmission risk with a novel tool: the Diabetes Early Readmission Risk Index (DERRI). 1508-P. American Diabetes Association 74th Scientific Sessions, 06/2014. San Francisco, CA. 2014.
25.
Rubin DJ, Recco D, Turchin A, Zhao H, Golden SH. External validation of the Diabetes Early Readmission Risk Indicator (DERRITM). Endocr Pract 2018. Endocrine-in Press-0035.
26.
Strack B, DeShazo JP, Gennings C, Olmo JL, Ventura S, Cios KJ, et al. Impact of HbA1c measurement on hospital readmission rates: analysis of 70,000 clinical database patient records. Biomed Res Int. 2014;2014:781670.CrossRefPubMedPubMedCentral
27.
Zapatero A, Gomez-Huelgas R, Gonzalez N, Canora J, Asenjo A, Hinojosa J, et al. Frequency of hypoglycemia and its impact on length of stay, mortality, and short-term readmission in patients with diabetes hospitalized in internal medicine wards. Endocr Pract. 2014:1–15.
28.
• Rubin D. Hospital readmissions of patients with diabetes. Curr Diab Rep. 2015;15:17. This important study reviews risk factors for readmissions and potential ways to reduce this risk . CrossRefPubMed
29.
Koproski J, Pretto Z, Poretsky L. Effects of an intervention by a diabetes team in hospitalized patients with diabetes. Diabetes Care. 1997;20(10):1553–5.CrossRefPubMed
30.
Davies M, Dixon S, Currie CJ, Davis RE, Peters JR. Evaluation of a hospital diabetes specialist nursing service: a randomized controlled trial. Diabet Med. 2001;18(4):301–7.CrossRefPubMed
31.
Wexler DJ, Beauharnais CC, Regan S, Nathan DM, Cagliero E, Larkin ME. Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge. Diabetes Res Clin Pract. 2012;98(2):249–56.CrossRefPubMedPubMedCentral
32.
• Dungan K, Lyons S, Manu K, Kulkarni M, Ebrahim K, Grantier C, et al. An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Endocr Pract. 2014;20(12):1265–73. This study highlights the importance of individualized inpatient diabetes education and transition program in diabetes patients . PubMed
33.
Umpierrez GE, Reyes D, Smiley D, Hermayer K, Khan A, Olson DE, et al. Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care. 2014;37(11):2934–9.CrossRefPubMedPubMedCentral
34.
Breuker C, Macioce V, Mura T, Audrier Y, Boegner C, Jalabert A, et al. Medication errors at hospital admission and discharge in type 1 and type 2 diabetes. Diabet Med. 2017;34(12):1742–6.CrossRefPubMed
35.
Breuker C, Abraham O, di Trapanie L, Mura T, Maciose V, Boeger C, et al. Patients with diabetes are at high risk of serious medication errors at hospital: interest of clinical pharmacist intervention to improve healthcare. Eur J Intern Med. 2017;38:38–45.CrossRefPubMed
36.
Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart MA, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25(4):284–90.CrossRefPubMedPubMedCentral
37.
Melton LD, Foreman C, Scott E, McGinnis M, Cousins M. Prioritized telephonic outreach reduces hospital readmissions for select high-risk patients. Am J Manag Care. 2012;18(12):838–44.PubMed
38.
Harrison JD, Auerbach AD, Quinn K, Kynoch E, Mourad M. Assessing the impact of nurse post-discharge telephone calls on 30-day hospital readmission rates. J Gen Intern Med. 2014;29(11):1519–25.CrossRefPubMedPubMedCentral
39.
Seggelke SA, Hawkins RM, Gibbs J, Rasouli N, Wang C, Draznin B. Transitional care clinic for uninsured and Medicaid-covered patients with diabetes mellitus discharged from the hospital: a pilot quality improvement study. Hosp Pract. 2014;42(1):46–51.CrossRef
40.
Jornsay DL, Garnett ED. Diabetes champions: culture change through education. Diabetes Spectr. 2014;27(3):188–92.CrossRefPubMedPubMedCentral
41.
Bouchonville MF, Hager BW, Kirk JB, Qualls CR, Arora S. Endo ECHO (Extension for Community Healthcare Outcomes) improves primary care provider and community health worker self-efficacy in complex diabetes management in medically underserved communities. Endocr Pract. 2018;24(1):40–6.CrossRefPubMed
42.
Magee MF, Khan NH, Desale S, Nassar CM. Diabetes to go: knowledge- and competency-based hospital survival skills diabetes education program improves post-discharge medication adherence. Diabetes Educ. 2014;40(3):344–50.CrossRefPubMed

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »