Anne L. Peters, MD, CDE; Kathleen M. Dungan, MD


June 28, 2013

Preventing Readmission With Diabetes Discharge Education

Dr. Peters: Tell me about your second presentation.

Dr. Dungan: Our second study[2] was on the effects of inpatient diabetes education on hospital readmissions. This has been an interest of mine for quite some time because I feel that the whole discharge process for patients with diabetes is often overlooked. It is overshadowed by whatever brings them into the hospital, which typically is not their diabetes. We try to make the discharge process more individualized rather than just teaching survival skills, which is the current standard of care. If a patient needs more advanced education in carbohydrate counting or insulin pump management, we will do that.

Furthermore, we will assist the teams in making discharge decisions as far as what the patient's medication should be, and of importance, what prescriptions and follow-up are needed. Education in this instance is multifaceted. We examined whether patients who were admitted with an A1c > 9% (a primary indication for obtaining a diabetes consult) benefitted from a reduction in readmissions. We found a remarkable reduction in readmissions, with an odds ratio of around 0.6 in patients who had a hospital inpatient diabetes consultation compared with those who didn't.

That finding held for 30-day readmissions and also for 180-day readmissions. We further adjusted our analyses for background factors, including demographics, whether the patient was admitted to an ICU, their hospital length of stay, and whether they had insurance coverage. We found that the odds ratios were attenuated somewhat, but they were still significant.

Dr. Peters: Did this education take place only in the hospital? It was not continued in the outpatient setting?

Dr. Dungan: That's correct.

Dr. Peters: That's fascinating. What do you think they learned that helped them to not be readmitted? You were looking at all readmissions, not just for diabetes, correct?

Dr. Dungan: We considered all hospital discharge diagnoses, whether the patient had a diagnosis of acute diabetes, infection, or cardiovascular disease. There are a couple of different explanations for our findings. First, it could be that they had better glycemic control, which then modified the outcomes of whatever morbidity was the cause of their admission. Second, it could be that having a diabetes educator involved made the whole discharge process more smooth. They might be more likely to have a primary care physician follow-up appointment, for example.

By empowering patients to manage their diabetes, they may also be more cognizant of other kinds of self-management behaviors. For example, patients with congestive heart failure might be more likely to adhere to other dietary instructions that they received.


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