Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital

Background: Community hospitals account for over 84% of all hospitals and over 94% of hospital admissions in the United States. In academic settings, implementation of an Inpatient Diabetes Management Service (IDMS) model of care has been shown to reduce rates of hyper- and hypoglycemia, hospital length of stay (LOS), and associated hospital costs. However, few studies to date have evaluated the implementation of a dedicated IDMS in a community hospital setting. Methods: This retrospective study examined the effects of changing the model of inpatient diabetes consultations from a local, private endocrine practice to a full-time endocrine hospitalist on glycemic control, LOS, and 30-day readmission rates in a 267-bed community hospital. Results: Overall diabetes patient days for the hospital were similar pre- and post-intervention (20,191 vs 20,262); however, the volume of patients seen by IDMS increased significantly after changing models. Rates of hyperglycemia decreased both among patients seen by IDMS (53.8% to 42.5%, P < .0001) and those not consulted on by IDMS (33.2% to 29.9%; P < .0001). When examined over time, rates of hypoglycemia steadily decreased in the 24 months after dedicated IDMS initiation ( P = .02); no such time effect was seen prior to IDMS ( P = .34). LOS and 30DRR were not significantly different between IDMS models. Conclusions: Implementation of an endocrine hospitalist-based IDMS at a community hospital was associated with significantly decreased hyperglycemia, while avoiding concurrent increases in hypoglycemia. Further studies are needed to investigate whether these effects are associated with improvements in clinical outcomes, patient or staff satisfaction scores, or total cost of care.

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Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2017-000460 ◽

2018 ◽

Vol 6 (1) ◽

pp. e000460 ◽

Cited By ~ 20

Author(s):

Vivek Bansal ◽

Adham Mottalib ◽

Taranveer K Pawar ◽

Noormuhammad Abbasakoor ◽

Eunice Chuang ◽

...

Keyword(s):

Readmission Rate ◽

Diabetes Management ◽

Group Versus ◽

Medical Services ◽

Critical Care Units ◽

Surgical Services ◽

Inpatient Diabetes ◽

Primary Service ◽

Inpatient Diabetes Management

ObjectiveWe compared the cost-effectiveness of two inpatient diabetes care models: one offered by a specialized diabetes team (SDT) versus a primary service team (PST).Research design and methodsWe retrospectively evaluated 756 hospital admissions of patients with diabetes to non-critical care units over 6 months. Out of 392 patients who met the eligibility criteria, 262 were matched 1:1 based on the mean of the initial four blood glucose (BG) values after admission. Primary outcomes were 30-day readmission rate and frequency, hospital length of stay (LOS) and estimated hospital cost. Secondary outcomes included glycemic control and BG variability.ResultsDiabetes complexity and in-hospital complications were significantly higher among patients treated by SDT versus PST. Thirty-day readmission rate to medical services was lower by 30.5% in the SDT group versus the PST group (P<0.001), while 30-day readmission rate to surgical services was 5% higher in the SDT group versus the PST group (P<0.05), but frequency of 30-day readmissions was lower (1.1 vs 1.6 times, P<0.05). LOS in medical services was not different between the two groups, but it was significantly longer in surgical services in SDT (P<0.05). However, LOS was significantly lower in patients who were seen by SDT during the first 24 hours of admission compared with those who were seen after that (4.7 vs 6.1 days, P<0.001). Compliance to follow-up was higher in the SDT group. These changes were translated into considerable cost saving.ConclusionsInpatient diabetes management by an SDT significantly reduces 30-day readmission rate to medical services, reduces inpatient diabetes cost, and improves transition of care and adherence to follow-up. SDT consultation during the first 24 hours of admission was associated with a significantly shorter hospital LOS.

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The Endocrine Hospitalist: Enhancing the Quality of Diabetes Care

Journal of Diabetes Science and Technology ◽

10.1177/19322968211007908 ◽

2021 ◽

pp. 193229682110079

Author(s):

Mihail Zilbermint

Keyword(s):

Hospital Readmission ◽

Community Hospital ◽

Diabetes Management ◽

Healthcare Systems ◽

Inpatient Diabetes ◽

Start Up ◽

Quality Of Diabetes Care ◽

Fellowship Programs ◽

Inpatient Diabetes Management

The endocrine hospitalist and inpatient diabetes management team increases access to endocrinology consultations and improves glycemic control and quality metrics such as length of stay and hospital readmission. Enhanced glycemic care is needed in both academic and community hospital settings. Endocrine fellowship programs should implement endocrine hospitalist rotations with emphasis on training endocrine fellows to deliver fast-paced inpatient endocrine care. Entrepreneurship, innovation, and a “start-up” culture within the field of Endocrinology should be encouraged and supported by healthcare systems.

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Evaluating the effect of inpatient diabetes education on length of stay, readmission rates and mortality rates: a systematic review

British Journal of Diabetes ◽

10.15277/bjd.2020.256 ◽

2020 ◽

Vol 20 (2) ◽

pp. 96-103

Author(s):

Zeeshan Hussain ◽

Mohammed Alkharaiji ◽

Iskandar Idris

Keyword(s):

Mortality Rate ◽

Length Of Stay ◽

Clinical Outcomes ◽

Readmission Rate ◽

Diabetes Education ◽

Free Text ◽

Readmission Rates ◽

Inpatient Diabetes ◽

Hospitalised Patients ◽

Patients With Diabetes

Background: Hospitalised patients with diabetes experience a longer duration of inpatient stay, increased readmission rates and excess mortality compared with patients without diabetes.Objectives: To determine whether inpatient diabetes education (IDE), provided to hospitalised patients with diabetes, is an effective intervention in improving one or all of the following clinical outcomes: length of stay (LOS), readmission rate and mortality rate.Methods: A free-text search on MEDLINE, PubMed, CINAHL, BNI and EMBASE was conducted on literature published from the date of each databases’ inception to March 2019. In addition, grey literature was used to support the search with the following key terms: ‘IDE’, ‘LOS’, ‘readmission’ and ‘mortality’, along with their possible substitutes and alternatives combined.Results: In total, eight studies met the inclusion criteria with a total number of 3,828 participants. Seven studies investigated LOS outcome for which accumulated mean LOS and median LOS were both lower (16.5% and 26.67%, respectively) in the IDE group compared with the non-IDE group. Six studies investigated readmittance rates, for which accumulated readmission rate (up to 12 months) was 15.9% lower in the IDE group than in the non-IDE group. Finally, the mortality rate was 36.6% lower in the IDE group compared with the non-IDE group, but this was non-significant and only one study reported this outcome.Conclusion: The findings of this review support the efficacy of an IDE programme in a hospital setting by reducing LOS and readmission rates in patients with diabetes. In addition, a possible trend towards a decreased mortality rate was observed. IDE is therefore recommended to improve clinical outcomes of hospitalised patients with diabetes.

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The Financial Impact of an Inpatient Diabetes Management Service

Current Diabetes Reports ◽

10.1007/s11892-020-01374-0 ◽

2021 ◽

Vol 21 (2) ◽

Author(s):

Waqas Zia Haque ◽

Andrew Paul Demidowich ◽

Aniket Sidhaye ◽

Sherita Hill Golden ◽

Mihail Zilbermint

Keyword(s):

Diabetes Management ◽

Financial Impact ◽

Management Service ◽

Inpatient Diabetes ◽

Inpatient Diabetes Management

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Individualizing Inpatient Diabetes Management During the Coronavirus Disease 2019 Pandemic

Journal of Diabetes Science and Technology ◽

10.1177/1932296820923045 ◽

2020 ◽

Vol 14 (4) ◽

pp. 705-707 ◽

Cited By ~ 6

Author(s):

Francisco J. Pasquel ◽

Guillermo E. Umpierrez

Keyword(s):

Healthcare Workers ◽

Diabetes Management ◽

Clinical Inertia ◽

Systematic Evaluation ◽

Individualized Care ◽

Inpatient Diabetes ◽

Diabetes Technology ◽

Patients With Diabetes ◽

Poor Outcomes ◽

Inpatient Diabetes Management

Diabetes is associated with poor clinical outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). During this pandemic, many hospitals have already become overwhelmed around the world and are rapidly entering crisis mode. While there are global efforts to boost personal protective equipment (PPE) production, many centers are improvising care strategies, including the implementation of technology to prevent healthcare workers’ exposures and reduce the waste of invaluable PPE. Not optimizing glycemic control due to clinical inertia driven by fear or lack of supplies may lead to poor outcomes in patients with diabetes and COVID-19. Individualized care strategies, novel therapeutic regimens, and the use of diabetes technology may reduce these barriers. However, systematic evaluation of these changes in care is necessary to evaluate both patient- and community-centered outcomes.

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