Evaluation of a Post Discharge Intervention on 30-Day Re-admission and Emergency Room Use in Patients with Diabetes A Pilot Program

Thesis (Master's)--University of Washington, 2016-06

University of Washington Abstract Evaluation of a Post Discharge Telephone Intervention on 30-day Re-admission and Emergency Room Use in Patients with Diabetes A Pilot Program Patricia Ann Montgomery Chair of the Supervisory Committee: Lloyd Mancl, Phd Adjunct Research Associate Professor, Biostatistics, School of Public Health Importance: Nearly nine million patients with diabetes are hospitalized annually in the United States, accounting for 23% of all hospitalizations and 43% of the total healthcare expenditure for diabetes. Patients with diabetes have higher thirty-day readmission rates, compared with readmission rates of patients without diabetes. Programs that aim to reduce thirty-day readmission rates for patients with diabetes can potentially improve care and cut costs. Objective: The primary aim of the Novo Nordisc Diabetes Topics Taught (NNDTT) program was to determine whether participation in the program would reduce the rate of readmission and emergency room utilization and to determine whether participation in the program resulted in improved patient follow-up. Secondary aims were to understand patient recall of inpatient diabetes education and to identify any resulting changes in diabetes self-care management. Design: The evaluation design is a quasi-experimental study comparing 30-day readmission rates, emergency room visits, and clinic encounters between discharged diabetic patients who completed at 4 least one post discharge NNDTT telephone interview and a group of discharged diabetic patients who did not complete any NNDTT post discharge telephone interviews. Setting: Harborview Medical Center, an urban, academic medical center and safety net hospital located in King County, Washington. Participants: English-speaking patients aged 18 and over admitted to the hospital for at least 24 hours who experienced two blood sugars > 180 mg/dl or one blood sugar < 70 mg/dl while hospitalized. All eligible patients had the diabetes education template “Diabetes Topics Taught” (DTT) activated in the electronic medical record by a member of the glycemic control team on day one of hospitalization and were discharged home after hospitalization. Main Outcomes and Measures: Primary outcome measures were 30-day hospital readmission, emergency department utilization and post-discharge follow-up appointments. Secondary outcomes included self-reported retention of diabetes education topics discussed during the interviews. Methods: Bivariate analysis was used to evaluate the NNDTT program using chi square test and Fischer’s exact test for categorical characteristics and clinical outcome measures, and Student’s t-test and Mann Whitney U test for continuous measures. Results: Five hundred and thirty eight patients were eligible for the NNDTT program and 68 (12.6%) completed at least one telephone interview. There was not a significant difference between the non-interviewed and interviewed cohorts in readmission rates (17.6% vs. 11.7%; p-value = 0.29) or emergency room visits (14.7% vs. 7.3%; p-value = 0.22). A significantly higher proportion of patients in the interviewed cohort completed post discharge follow-up appointments as compared to the eligible group (19.1% vs. 5.6%; p-value < .001). Conclusions: An expanded phone call interview focusing on diabetes self-management skills resulted in higher rates of follow-up encounters. There was not a significant difference in readmission rates or emergency room utilization.