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Kukde RD, Chakraborty A, Shah J. A Systematic Review of Recent Studies on Hospital Readmissions of Patients With Diabetes. Cureus 2024; 16:e67513. [PMID: 39310630 PMCID: PMC11416148 DOI: 10.7759/cureus.67513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Hospital readmissions are a major area of concern across the healthcare ecosystem. Diabetes mellitus (DM) and associated complications significantly contributed to hospital readmissions in 2018, placing it among the leading causes alongside septicemia and heart failure. Diabetes is an urgent public health concern that has reached epidemic proportions globally. Compared to the early 2000s, the prevalence of diabetes among individuals aged 20-79 years in the US has significantly increased. This research provides an in-depth examination of diabetes-related hospital readmissions and reviews recent studies (2015-2023) to understand the characteristics, risk factors, and potential outcomes for re-admitted diabetes patients. The study identified 21 articles that met the inclusion criteria to provide valuable insights and analyze risk factors associated with these readmissions. The findings indicated that risk factors such as age, demographics, income, insurance type, severity of illness, and comorbidities among diabetic patients were critical and warranted further investigation. Diabetes awareness, quality of hospital care, involvement of healthcare providers, timely screening, and lifestyle changes were noted as important factors to improve the effectiveness of healthcare delivery, reduce diabetes-related complications, and eventually lower preventable hospital readmissions.
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Affiliation(s)
- Ruchi D Kukde
- Department of Organization, Workforce, and Leadership Studies, Texas State University, San Marcos, USA
| | - Aindrila Chakraborty
- Department of Information Systems and Analytics, Texas State University, San Marcos, USA
| | - Jaymeen Shah
- Department of Information Systems and Analytics, Texas State University, San Marcos, USA
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Whillier M, Hinton N, Balcerek M, MacLaughlin HL, Donovan P. Queensland Inpatient Diabetes Survey (QuIDS): patient experience survey evaluation. Intern Med J 2024; 54:639-646. [PMID: 37792317 DOI: 10.1111/imj.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Measurement of inpatient experience can allow for treatment tailored to patient preferences and needs. The patient experience of diabetes care has not been explored in Queensland hospitals. AIMS To investigate the experiences of patients with diabetes when hospitalised using the Queensland Inpatient Diabetes Survey (QuIDS). METHODS In 2019 and 2021, patient experience surveys were collected as part of the statewide QuIDS, a cross-sectional study assessing the quality of inpatient care received by people with diabetes in Queensland, Australia. Patient responses were categorised and frequencies reported as percentages. Free text comments were analysed using thematic analysis methods. Pooled descriptive data were presented. RESULTS Responses were collected from 27 hospitals in 2019 (n = 526, 52.4% of all patients with diabetes) and 35 hospitals in 2021 (n = 709, 55.5%). Overall, patients were satisfied with their inpatient diabetes care. Areas for improvement identified by surveyed patients include the choice and timing of meals, staff knowledge about diabetes and increased diabetes self-management. Access to a specialist diabetes team was also identified as being potentially underutilised. Patient comments fell into four major themes: communication, food choices, patient autonomy and education. CONCLUSION Many patients reported positive inpatient experiences; however, patients also expressed dissatisfaction with their inpatient diabetes care. Our data provide unique insight and an opportunity to improve standards of care and service provision for inpatients with diabetes.
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Affiliation(s)
- Margaret Whillier
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Nicola Hinton
- Cairns Diabetes Service, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Matthew Balcerek
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Peter Donovan
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, Unversity of Queensland, Brisbane, Queensland, Australia
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Dei Cas A, Aldigeri R, Ridolfi V, Vazzana A, Ciardullo AV, Manicardi V, Sforza A, Tomasi F, Zavaroni D, Zavaroni I, Bonadonna RC. Efficacy of a training programme for the management of diabetes mellitus in the hospital: A randomized study (stage 2 of GOVEPAZ healthcare). Diabetes Metab Res Rev 2023; 39:e3708. [PMID: 37574863 DOI: 10.1002/dmrr.3708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/24/2023] [Accepted: 06/25/2023] [Indexed: 08/15/2023]
Abstract
AIMS To assess the efficacy of a structured educational intervention for health professionals on the appropriateness of inpatient diabetes care and on some clinical outcomes in hospitalised subjects. METHODS A multicentre (6 regional hospitals) cluster-randomized (2:1) two parallel-group pragmatic intervention trials, as a part of the GOVEPAZ study, was conducted in three clinical settings, that is, Internal Medicine, Surgery and Intensive Care. Intervention consisted of a 2-month structured education of clinical staff to inpatient diabetes care. Twelve wards - 2 for each hospital - and 6 wards - 1 for each hospital - were randomized to usual care and to the intervention arm, respectively. Consecutively hospitalised diabetic subjects (n = 524, age 74 ± 14 years, 57% males, median HbA1C 57 mmol/mol) were included. The clinical appropriateness of inpatient diabetes management was assessed by a previously validated multi-domain performance score (PS). Clinical outcomes included hypoglycemia, glucose control biomarkers, clinical conditions at discharge and inpatient mortality rate. RESULTS A numerically, but not statistically significant, higher PS (+0.94; 95% C.I.: -0.53 - +2.4) was achieved in the intervention than in the usual care wards. Hypoglycemias (p = 0.32), glucose control (p = 0.89) and survival rates (p = 0.71) were similar in the two experimental arms. Plasma glucose on admission (OR = 1.52 per 1 SD; C.I. 1.07-2.17; p = 0.021) and the number of hypoglycemic events per patient (OR = 1.55 per 1 SD; C.I.:1.11-2.16; p = 0.011) were independently associated with the inpatient mortality rate. CONCLUSIONS Structured education of the clinical staff failed to improve the inpatient appropriateness of diabetes care or clinical outcomes. In-hospital hypoglycemia was confirmed to be an independent indicator of death risk.
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Affiliation(s)
- Alessandra Dei Cas
- Department of Medicine and Surgery, Università di Parma, Parma, Italy
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Valentina Ridolfi
- Department of Medicine and Surgery, Università di Parma, Parma, Italy
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Angela Vazzana
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | | | | | | | | | - Ivana Zavaroni
- Department of Medicine and Surgery, Università di Parma, Parma, Italy
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Riccardo C Bonadonna
- Department of Medicine and Surgery, Università di Parma, Parma, Italy
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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Cai J, Islam MS. Interventions incorporating a multi-disciplinary team approach and a dedicated care team can help reduce preventable hospital readmissions of people with type 2 diabetes mellitus: A scoping review of current literature. Diabet Med 2023; 40:e14957. [PMID: 36082498 PMCID: PMC10087324 DOI: 10.1111/dme.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
AIMS This review aimed to identify interventions that hospitals can implement to reduce preventable hospital readmissions of people with type 2 diabetes mellitus (T2DM). METHODS A scoping review framework was utilised to inform the overall process. The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, the University of New England (UNE) library search engine and Google Scholar were utilised to search for relevant literature. RESULTS The results from this review demonstrate that interventions started at index admission for people diagnosed with T2DM can result in reductions in hospital readmissions. Common strategies which attributed to the success of interventions in reducing hospital readmissions of people with T2DM included a multidisciplinary team approach, a dedicated care team, certified diabetes educator appointments, basic survival skills education and influencing hospital protocol development and implementation. CONCLUSION This scoping review is an attempt at exploring and synthesising current research on interventions that hospitals can implement to reduce preventable hospital readmissions of people with T2DM.
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Affiliation(s)
- James Cai
- Tamworth Rural Referral Hospital, Tamworth, New South Wales, Australia
| | - Md Shahidul Islam
- Faculty of Medicine and Health, School of Health, University of New England, Armidale, New South Wales, Australia
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Liao WT, Lee CC, Kuo CL, Lin KC. Predicting readmission due to severe hyperglycemia after a hyperglycemic crisis episode. Diabetes Res Clin Pract 2022; 192:110115. [PMID: 36220515 DOI: 10.1016/j.diabres.2022.110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/20/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022]
Abstract
AIM This study aimed to investigate the readmission pattern and risk factors for patients who experienced a hyperglycemic crisis. METHODS Patients admitted to MacKay Memorial Hospital for diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS) between January 2016 and April 2019 were studied. The timing of the first readmission for hyperglycemia and other causes was recorded. Kaplan-Meier analysis was used to compare patients with hyperglycemia and all-cause readmissions. Cox regression was used to identify independent predictors for hyperglycemia and all-cause readmission post-discharge. RESULTS The study cohort included 410 patients, and 15.3 % and 46.3 % of them had hyperglycemia and all-cause readmissions, respectively. The DKA and HHS group showed a similar incidence for hyperglycemia, with the latter group showing a higher incidence of all-cause readmissions. The significant predictors of hyperglycemia readmissions included young age, smoking, hypoglycemia, higher effective osmolality, and hyperthyroidism in the DKA group and higher glycated hemoglobin level in the HHS group. CONCLUSIONS Patients who experienced DKA and HHS had similar hyperglycemia readmission rates; however, predictors in the DKA group were not applicable to the HHS group. Designing different strategies for different types of hyperglycemic crisis is necessary for preventing readmission.
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Affiliation(s)
- Wei-Tsen Liao
- Division of Endocrinology & Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, 92, Sec. 2, Zhongshan N. Rd, Zhongshan Dist., Taipei City 10449, Taiwan, ROC; Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City 25245, Taiwan, ROC; Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC
| | - Chun-Chuan Lee
- Division of Endocrinology & Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, 92, Sec. 2, Zhongshan N. Rd, Zhongshan Dist., Taipei City 10449, Taiwan, ROC; Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City 25245, Taiwan, ROC
| | - Chih-Lin Kuo
- Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC; Yong Cheng Rehabilitation Clinic, Taipei City 10663, Taiwan, ROC
| | - Kuan-Chia Lin
- Community Medicine Research Center, Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, 155, Sec. 2, Linong St., Beitou District, Taipei City 11221, Taiwan, ROC; Cheng Hsin General Hospital, Taipei, Taiwan, ROC.
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Hall L, Islam MS. Key Considerations for Understanding Usability of Digital Health Initiatives for Adults With Type 2 Diabetes: A Systematic Qualitative Literature Review. J Diabetes Sci Technol 2022; 17:833-842. [PMID: 35128964 DOI: 10.1177/19322968221075322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The rapidly growing number of adults with type 2 diabetes globally means the uses and benefits of digital health initiatives to enhance self-management of diabetes warrant review. This systematic qualitative literature review aimed to understand usability of digital health initiatives for adults with type 2 diabetes. METHODS This systematic qualitative literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the PRISMA 2020 Statement methodology. Three databases were used (SCOPUS, Medline, and CINAHL) to identify studies published from 2016 to 2021 that focused on experiences, evaluations, and usability of digital health initiatives aimed at helping adults with type 2 diabetes to self-manage their condition. RESULTS From the 407 studies identified, 35 studies were assessed for eligibility with 10 studies included in the final synthesis. Five main themes emerged: (1) unmet emotional needs, (2) enhancing self-management, (3) desire for education, (4) usability/user-experience, and (5) risk of biomedical marker reductionism. CONCLUSIONS This review identified 5 key themes for consideration to understand usability of digital health initiatives. If these unmet psychosocial needs of adults with type 2 diabetes are better addressed in digital health initiatives, enhanced daily self-management will lead to more optimal diabetes management which can increase overall health outcomes, reduce the risk of longer-term complications, enhance quality of life for type 2 diabetes and improve more widespread adoption of digital health initiatives.
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Affiliation(s)
- Larissa Hall
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Md Shahidul Islam
- School of Health, University of New England, Armidale, New South Wales, Australia
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