Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital
Retrospective study of inpatient diabetes management service, length of stay and 30-day readmission rate of patients with diabetes at a community hospital
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DOI：
10.1080/20009666.2019.1593782
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发表时间：
2019-03-04
影响因子：
1
通讯作者：
Zilbermint, Mihail
中科院分区：
文献类型：
--
作者：
Mandel, Samantha R.;Langan, Susan;Zilbermint, Mihail
背景：糖尿病住院患者有并发症的风险，住院时间较长。众所周知，住院糖尿病管理服务（IDMS）是有益的;然而，其对社区非教学医院患者护理措施的影响尚不清楚。目的：评估IDMS团队共同管理糖尿病患者是否降低了LOS和30天再入院率（30 DR）。方法：本回顾性质量改进队列研究分析了社区医院收治的糖尿病患者的LOS和30 DR。IDMS医疗团队由内分泌学家、执业护士和糖尿病教育者组成。对照组由接受标准护理的住院糖尿病患者组成，这些患者由主治医生（大多数是受过内科培训的住院医生）治疗。使用广义估计方程模型评估研究组与结果变量之间的关系。结果：2016年1月至2017年5月期间，共收治了4，654例糖尿病患者（70.8 ± 0.2岁）。IDMS团队共同管理18.3%的患者，大多数患者的疾病严重程度评分较高（p < 0.0001）。由IDMS团队共同管理的患者的平均LOS下降了27%。IDMS组中位LOS随时间推移而降低（p = 0.046），而对照组中未观察到显著降低。IDMS联合管理患者的平均30 DR降低了10.71%。IDMS联合管理的患者中位30 DR降低（p = 0.048）。结论：在社区医院环境中，由专业糖尿病团队共同管理的患者的LOS和30 DR显著降低。这些变化可以转化为可观的成本节约。
Background: Hospitalized patients with diabetes are at risk of complications and longer length of stay (LOS). Inpatient Diabetes Management Services (IDMS) are known to be beneficial; however, their impact on patient care measures in community, non-teaching hospitals, is unknown. Objectives: To evaluate whether co-managing patients with diabetes by the IDMS team reduces LOS and 30-day readmission rate (30DR). Methods: This retrospective quality improvement cohort study analyzed LOS and 30DR among patients with diabetes admitted to a community hospital. The IDMS medical team consisted of an endocrinologist, nurse practitioner, and diabetes educator. The comparison group consisted of hospitalized patients with diabetes under standard care of attending physicians (mostly internal medicine-trained hospitalists). The relationship between study groups and outcome variables was assessed using Generalized Estimating Equation models. Results: 4,654 patients with diabetes (70.8 +/- 0.2 years old) were admitted between January 2016 and May 2017. The IDMS team co-managed 18.3% of patients, mostly with higher severity of illness scores (p < 0.0001). Mean LOS in patients co-managed by the IDMS team decreased by 27%. Median LOS decreased over time in the IDMS group (p = 0.046), while no significant decrease was seen in the comparison group. Mean 30DR in patients co-managed by the IDMS decreased by 10.71%. Median 30DR decreased among patients co-managed by the IDMS (p = 0.048). Conclusions: In a community hospital setting, LOS and 30DR significantly decreased in patients co-managed by a specialized diabetes team. These changes may be translated into considerable cost savings.