Capsule Commentary on McCoy Et al. Hospital Readmissions Among Commercially-Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events.
Capsule Commentary on McCoy Et al. Hospital Readmissions Among Commercially-Insured and Medicare Advantage Beneficiaries with Diabetes and the Impact of Severe Hypoglycemic and Hyperglycemic Events.
复制标题
麦考伊等人的胶囊评论。
DOI：
10.1007/s11606-017-4109-8
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发表时间：
2017
影响因子：
5.7
通讯作者：
Zullo,AndrewR
中科院分区：
文献类型：
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作者：
Zullo,AndrewR
他的回溯性队列研究，由McCoy等人进行。1使用来自商业保险和患有糖尿病的医疗保险优势受益人的管理数据来描述因严重血糖障碍(低血糖和高血糖)和其他原因而再次住院的相对频率。它还检查了此类事件的潜在预测因素。作者发现，全原因30天再住院率为10.8%。心力衰竭是再入院的最常见原因(8.9%)，严重血糖异常占再入院的2.5%(高血糖38.3%，低血糖61.0%，不明原因0.7%)。相对于其他原因，较年轻的年龄、血糖异常病史和较高的糖尿病并发症严重程度指数评分是严重血糖异常的独立预测因素。大多数使用管理数据的血糖紊乱研究2仅限于对严重事件的评估，因为轻中度事件(1)最有可能发生在临床护理之外的环境中，(2)不太可能被记录为临床相遇或支付医疗服务的理由。因此，本研究没有涉及轻度中度血糖异常的流行病学和后果，在经验性文献中对其了解较少。3未来在大规模人群中的研究应致力于评估轻度至中度血糖紊乱，并通过利用电子健康记录中的信息建立管理数据，包括结构化数据字段和自由文本临床笔记。3这些额外的数据将有助于提供对血糖异常的更全面的了解，从而最好地提供最佳的过渡性和非卧床护理实践，并允许针对糖尿病高危个体进行干预。
T his retrospective cohort study by McCoy et al. 1 used administrative data from commercially insured and Medicare Advantage beneficiaries with diabetes to describe the relative frequency of hospital readmissions for severe dysglycemia (hypoglycemia and hyperglycemia) and other causes. It also examined potential predictors of such events. The authors found that the all-cause 30-day readmission rate was 10.8%. Heart failure was the most common cause for readmission (8.9%), and severe dysglycemia accounted for 2.5% of readmissions (38.3% hyperglycemia, 61.0% hypoglycemia, 0.7% unspecified). Younger age, history of dysglycemia, and a higher Diabetes Complications Severity Index score were independent predictors of severe dysglycemia relative to other readmission causes. Most studies of dysglycemia using administrative data 2 have been limited to the assessment of severe events because mild-to-moderate events are (1) most likely to occur in settings outside of clinical care and (2) are unlikely to be recorded as justification for a clinical encounter or payment of health services. The epidemiology and consequences of mild-tomoderate dysglycemia are therefore unaddressed by this study and are much less well understood in the empirical literature. 3 Future studies in large populations should strive to assess mild-to-moderate dysglycemia and build on administrative data by leveraging the information in electronic health records, including both structured data fields and free-text clinical notes. 3 These additional data will help to provide a more complete understanding of dysglycemia that best informs optimal transitional and ambulatory care practices and permits targeting of interventions to individuals with diabetes at highest risk.