Inpatient Diabetes Education Reduces Readmissions Rate

Hand writing diabetes healthcare content with blue marker on virtual whiteboardInpatient diabetes education was associated with 34% reduced risk of all-cause readmissions within 30 days, and 20% reduced risk of readmissions at 180 days, after adjustment for other potentially confounding variables, in a retrospective study published in Diabetes Care.

“Hospital readmission is an important contributor to total medical expenditures and an emerging indicator of quality of care,” said Sara J. Healy, MD, endocrinology fellow at Ohio State University Wexner Medical Center in Columbus, Ohio. “Hospitals have started to incur penalties for readmission within 30 days for certain conditions and other medical conditions are expected to be added,” Dr. Healy said.

The objective of the retrospective study was to explore the relationship between inpatient diabetes education, conducted by a dedicated trained diabetes educator, and hospital readmissions in patients with poorly controlled diabetes (A1C>9%) hospitalized between 2008 and 2010, Dr. Healy said. A total of 2,265 patients was included in the 30-day analysis, and 2,069 patients were included in the 180-day analysis. Most of the patients were initially admitted for reasons other than uncontrolled diabetes.

Inpatient Diabetes Education Linked to 34% Reduced Risk for Readmission
“Patients who received inpatient diabetes education (IDE) had a lower frequency of readmission within 30 days than did those who did not (11% vs 16%; P=0.0001),” Dr. Healy said. After adjusting for sociodemographic and illness-related factors, IDE was associated with a lower risk for readmission (odds ratio, 0.66; P=0.001). Other independent predictors of readmission included Medicaid insurance and longer hospital stay. The beneficial effect of diabetes education on reduced risk for hospital readmission was maintained at 180 days, but was attenuated.

“The study suggests that IDE remains an important component of diabetes care. Randomized, controlled trials are needed to determine whether IDE improves readmission rates for patients with poorly controlled diabetes and whether this intervention is cost-effective,” Dr. Healy said.

“The study found an association of a ‘diabetes education consult’ order in their electronic system with a reduced risk for 30-day all-cause readmission,” commented Nancy Wei, MD, Instructor in Medicine a Massachusetts General Hospital, Boston, Mass. “While this association is compelling, it is not clear whether the association is driven by ‘inpatient diabetes education’ or the additional care coordination provided by the inpatient diabetes educator,” Dr. Wei said.

“Causation cannot be determined in this retrospective study, and the authors were not able to account for potential bias by indication that could be driving differential referral patterns for diabetes education, such as illness severity and discharge to facility other than home,” Dr. Wei said.

The Importance of Specialized Diabetes Treatment
“It is notable that >60% of adult patients with >9% A1C at their institution received some specialized diabetes treatment, whether diabetes physician consult, education consult or both,” Dr. Wei commented. “This is to be highlighted and commended. The role of the diabetes educator in the inpatient care at their institution goes beyond teaching survival skills, but also providing medication reconciliation, assessing barriers and follow-up needs, and ensuring appropriate prescriptions for diabetes medications and supplies. Navigating the latter, especially ensuring adequate insurance coverage for their medications and supplies should not be overlooked in its importance in adherence to treatment recommendations after discharge. There is clearly an added level of care coordination that goes beyond educating the patients on diabetes survival skills that should be recognized as potentially contributing to their findings,” Dr Wei said.

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