Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 13

13 - ANALYSIS OF READMISSIONS AND FOLLOWUP AMONG PATIENTS WITH SEVERE UNCONTROLLED DIABETES IN AN URBAN HOSPITAL -IMPLICATIONS FOR OPTIMIZATION

Thursday, Apr 25
1:00 PM – 1:30 PM

Objective :

Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar State (HHS) are complications of diabetes resulting in long hospitalizations, usually including time in the Intensive Care Unit. Many factors have been analyzed as potential predictors of re-admissions for DKA/HHS but no universal set of factors can be applied to the diverse population of different hospitals. In this quality improvement study, we aim to look retrospectively to determine i1. the frequencyof readmissions and 2. actionable trends in patients readmitted for DKA/HHS at our facility. 


Methods : This was a quality improvement, retrospective chart review to identify readmission rates of  uncontrolled diabetes  relative to  the type of discharge plan that was presented to the patient


Results :

A sample of 101 patients presented for severe uncontrolled diabetes (February 2015 to January 2018), accounting for 138 visits.  42/101 (41.6%)  had repeat admissions or emergency room (ER) visits.  Of these, 26 were inpatient re-admissions , 12 were ER re-visits and 4 were both. Of the 101 patients, 13 (12.9%) patients were followed by the hospital diabetes clinic, 32 (31.7%) by their primary care doctor or private doctor, 32 (31.7%) had no doctor and were referred to the facility’s diabetes clinic but never had a visit, and 23 (22.8%) patients did not receive have any type of follow up. The rates of re-hospitalization for the 4 groups were similar: 7/13 (53.8%), 13/32 (40.6%), 11/32 (34.4%), and 11/23 (47.8%), respectively. 


17/101 (15.8%) patients were diagnosed with new onset diabetes but only 2/17 (11.8%) of them were tested for GAD and/or islet cell antibodies. Only 11/101 (10.9%) patients were tested for GAD and/or Islet Cell Antibodies.  Antibodies were elevated in 3/11 (27.3%) patients, suggesting that DKA and severe hyperglycemia in an urban minority hospital is less likely to be autoimmune type 1 diabetes.


Discussion :

The  rate of readmissions  within 3 years was high (42%) among our urban minority patients  admitted for severe, uncontrolled diabetes including DKA. Readmission rates were similarly associated with several types of discharges.One third of the patients never received a discharge plan and another third did not get to their followup appointment .
Our quality improvement study resulted in a recognition of the importance of followup after discharge and a renewed effort to ensure that these high risk urban minority patients have timely and affordable access to the hospital’s outpatient  clinics or their private clinician.  
 


Conclusion : Improved followup on discharge will decrease readmission rates for uncontrolled diabetes among urban minorty patients,  decrease hospital costs and improve clinical outcomes.

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Moin U. Sattar

Resident in Medicine
SUNY Downstate Medical Center and Kings County Hospital
Brooklyn, New York

Resident in Medicine

Alice Yau

Resident in Medicine
SUNY Downstate Medical Center and Kings County Hospital
Brooklyn, New York

Resident in Medicine

Naseem Hossain

Resident in Medicine
SUNY Downstate Medical Center and Kings County Hospital
Brooklyn, New York

Resident in Medicine

Mary Ann Banerji

Professor of Medicine, Division Chief
SUNY Downstate Medical Center and Kings County Hospital, Brooklyn NY
Brooklyn, New York

Professor of Medicine