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Hospital Readmission Diabetes

Predicting And Preventing Hospital Readmission In Patients With Diabetes And Cvd Rubin, Daniel J. Temple University, Philadelphia, Pa, United States

Predicting And Preventing Hospital Readmission In Patients With Diabetes And Cvd Rubin, Daniel J. Temple University, Philadelphia, Pa, United States

Predicting and Preventing Hospital Readmission in Patients with Diabetes and CVD The overall goal of this K23 proposal is to train Daniel J. Rubin, MD, MSc for a career as an independent investigator in the prediction and prevention of hospital readmission among patients with diabetes. Readmissions within 30 days of discharge (30d readmissions) are a high-priority quality measure and target for cost reduction. Patients with diabetes and cardiovascular disease (CVD) are disproportionately over- represented in 30d readmissions, especially among racial minorities and urban populations. Currently there is no validated method to identify diabetic patients admitted for CVD at the highest risk of 30d readmission, which is a critical prerequisite for targeting limited resources fr reducing readmission risk to those most in need. Furthermore, there are no proven interventions to reduce the risk of 30d readmission specifically among patients with diabetes. Dr. Rubin plans to address these gaps in knowledge with 2 aims, 1) validating and refining a Diabetes Early Readmission Risk Index (DERRI-CVD) for predicting 30d readmission risk in diabetic patients admitted for CVD, and 2) assessing the feasibility and acceptability of a novel, multifactorial intervention designed to reduce 30d readmissions. The intervention adapts methods successfully used in other inpatient populations to diabetic patients hospitalized for CVD and will target those identified as high risk for readmission based on the DERRI-CVD. There are 2 Phases to the proposed research that address these aims: Phase 1 uses a new retrospective cohort of diabetic patients to validate and refine the DERRI-CVD for prediction of 30d readmission risk; Phase 2 involves a single-arm pilot trial to qualitatively assess the feasib Continue reading >>

Hospital Readmission Of Patients With Diabetes.

Hospital Readmission Of Patients With Diabetes.

Curr Diab Rep. 2015 Apr;15(4):17. doi: 10.1007/s11892-015-0584-7. Hospital readmission of patients with diabetes. Section of Endocrinology, Diabetes, and Metabolism, School of Medicine, Temple University, 3322 N. Broad ST., Ste 205, Philadelphia, PA, 19140, USA. [email protected] Correction to: Hospital Readmission of Patients with Diabetes. [Curr Diab Rep. 2018] Hospital readmission is a high-priority health care quality measure and target for cost reduction. Despite broad interest in readmission, relatively little research has focused on patients with diabetes. The burden of diabetes among hospitalized patients, however, is substantial, growing, and costly, and readmissions contribute a significant portion of this burden. Reducing readmission rates of diabetic patients has the potential to greatly reduce health care costs while simultaneously improving care. Risk factors for readmission in this population include lower socioeconomic status, racial/ethnic minority, comorbidity burden, public insurance, emergent or urgent admission, and a history of recent prior hospitalization. Hospitalized patients with diabetes may be at higher risk of readmission than those without diabetes. Potential ways to reduce readmission risk are inpatient education, specialty care, better discharge instructions, coordination of care, and post-discharge support. More studies are needed to test the effect of these interventions on the readmission rates of patients with diabetes. Continue reading >>

Link Between Diabetes And Hospital Readmission Rates

Link Between Diabetes And Hospital Readmission Rates

Link Between Diabetes and Hospital Readmission Rates Link Between Diabetes and Hospital Readmission Rates Patients who received diabetes services had lower rates of ED and observation readmissions, but not inpatient readmissions. Patients with diabetes have higher rates of hospital readmission compared with patients without diabetes, according to a pilot study published in Clinical Diabetes and Endocrinology. Researchers from the University of Michigan in Ann Arbor conducted 2 studies using different datasets. The first was a retrospective review of all patients admitted (n=7763) to any adult service within the University of Michigan Health System with a principal or secondary admission diagnosis of diabetes followed by an uncontrolled analysis of patients with a principal admission diagnosis of diabetes. The second analysis was a larger retrospective study (n=37,702) of all adults discharged from the University of Michigan Health System with a principal or secondary discharge diagnosis of diabetes. In the first study, the readmission rate was 26% in patients with diabetes vs 22% in patients without diabetes. The most common cause for readmission was diabetes-related in patients with a principal diagnosis of diabetes on index admission, whereas the most common cause for readmission in patients with a secondary diagnosis of diabetes was infection-related. Of the patients with diabetes, approximately only 12% received any type of diabetes service consult (eg, Hyperglycemic Intensive Insulin Program [HIIP] or Endocrine Consults [ENDO]). Patients who received diabetes services had lower rates of emergency department and observation readmissions (6.6% HIIP or ENDO vs 9.6% no HIIP or ENDO; P =.0012), although there were no differences in the inpatient readmission rates (17.6 Continue reading >>

Diabetes Health In The News: Diabetics Have A Higher Readmission Rate To Hospitals, Study Finds

Diabetes Health In The News: Diabetics Have A Higher Readmission Rate To Hospitals, Study Finds

Diabetes Health in The News: Diabetics Have a Higher Readmission Rate to Hospitals, Study Finds A research team from the University of Michigan in Ann Arbor has found a link between those with diabetes and those patients with higher hospital readmission rates. The researchers analyzed two different sets of patient data to reach this conclusion. Both sets of data looked at patients who had been admitted to the University of Michigan Health System (UMHS). The first set of data contained 7,763 records of those who received an admission diagnosis of diabetes. The second contained 37,702 records of patients who received a discharge diagnosis of diabetes. When comparing readmission rates to those of patients without diabetes, the first data set showed that 26% of diabetics were readmitted, while only 22% of those without the disease were. The study did look at diabetic services and readmission rates, and while the early indication is that those who do make use of diabetic services have fewer ER visits, this area does require additional research These findings were published in Clinical Diabetes and Endocrinology on March 22, 2017. Your email address will not be published. Required fields are marked * Time limit is exhausted. Please reload CAPTCHA. The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. Opinions expressed here are the opinions of writers, contributors, and commentators, and are not necessarily those of Diabetes Health. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on Continue reading >>

Inpatient Diabetes Education Seems To Reduce Readmissions

Inpatient Diabetes Education Seems To Reduce Readmissions

Inpatient Diabetes Education Seems to Reduce Readmissions CHICAGO Formal inpatient diabetes education was associated with a reduction in the rate of hospital readmission for patients with poorly controlled diabetes, a new study has found. Another study, of Medicare beneficiaries with type2 diabetes, found that major risk factors for readmission are patient complexity, older age, and longer duration of initial hospital stay. Both studies were presented here at the American Diabetes Association (ADA) 2013 Scientific Sessions , the first by SaraJ. Healy, MD, a soon-to-be endocrinology fellow at the Ohio State University Medical Center in Columbus, and the second by Sandipan Bhattacharjee, a graduate student in pharmaceutical systems and policy at the RobertC. Byrd Health Sciences Center in Morgantown, West Virginia. Hospital readmission is a major target of healthcare quality-improvement efforts. Since October 2012, hospitals have had their Medicare reimbursement cut if their 30-day readmission rates for pneumonia, heart failure, and heart attacks exceed a certain threshold. It is expected that other conditions will be added, Dr. Healy noted in her presentation. "There is unlikely to be a magic bullet to reduce readmissions; this seems to be true among patients with diabetes as well," said Kasia Lipska, MD, an endocrinologist from the Yale University School of Medicine in New Haven, Connecticut, who has conducted research into hospital-related issues in Medicare beneficiaries with diabetes. "Patients who are particularly vulnerable to begin with, such as those who are older and have multiple comorbidities, appear to be most likely to be readmitted," she told Medscape Medical News. "Complex patients with diabetes may be vulnerable to multiple complications following admiss Continue reading >>

Preventing Hospital Readmissions

Preventing Hospital Readmissions

In virtually every health insurance plan in the United States, hospitals and doctors are paid a set price for each service or procedure they perform. While this system makes sense in many ways, it has long been known to lead to an unfortunate set of incentives: Since hospitals get paid more for admitting more patients and performing more procedures, they have no natural financial interest in preventing future complications or hospitalizations resulting from the procedures they perform. As part of the Affordable Care Act (Obamacare), the 2010 health-care reform law, Congress tried to remedy this situation by tying certain Medicare payments to hospitals readmission rates following certain procedures. Specifically, as described last week in a Kaiser Health News article, Medicare the federal health insurance program for older adults and others began to look at readmissions after Medicare patients were hospitalized for five common reasons: heart attack, heart failure, pneumonia, a chronic lung condition, or hip or knee replacement. For each hospital, Medicare then compared the number of people readmitted within a month of each hospitalization with what it thought the number should be, based on the hospitals mix of patients and nationwide readmission rates. If a hospitals readmission rate is higher than Medicare thinks it should be, the agency penalizes that hospital during the next fiscal year by paying it less for hospitalizations in the five categories. Since these penalties began three years ago, readmissions have fallen, but about one in five Medicare patients still returns to the hospital within a month of being discharged. As noted in the Kaiser article, the amount of the Medicare penalty varies, and the number of hospitals penalized varies widely by state. The fines Continue reading >>

Readmission Prevention Pilot Trial In Diabetes Patients

Readmission Prevention Pilot Trial In Diabetes Patients

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Readmission Prevention Pilot Trial in Diabetes Patients The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT03243383 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Information provided by (Responsible Party): Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information Post-discharge hospital utilization, i.e., readmissions within 30 days of discharge (30d readmissions) and emergency department (ED) visits, are a high-priority quality measure and target for cost reduction. Patients with diabetes are disproportionately over-represented in 30d readmissions, especially among racial minorities and urban populations. We have developed and validated a tool, the Diabetes Early Readmission Risk Indicator (DERRI), to predict 30d readmission risk among diabetes patients, which is a critical prerequisite for targeting limited resources for reducing readmission risk to those most in need. Currently, there are no proven interventions to reduce the risk of 30d readmission specifically among patients with diabetes. This proposal will assess the feasibility and acceptability of a novel, multifactorial intervention, the Diabetes Transition of Hospital Care Program (DiaTOHC), designed to reduce post-discharge hospital utilization rates in a pilot randomized Continue reading >>

What Are Predictors Of Medication Change And Hospital Readmission In Diabetic Patients?

What Are Predictors Of Medication Change And Hospital Readmission In Diabetic Patients?

What are Predictors of Medication Change and Hospital Readmission in Diabetic Patients? Utilizing a US Hospital encounter dataset of over 70,000 unique patients, we attempted to determine the predictors of medication change as well as readmission within 30 days, in diabetics who get admitted to a hospital. We employed extensive preprocessing including data cleaning, standardization, log transformations, data balancing and feature engineering. Modeling was done using logistic regression, decision trees and random forests. Abnormal HbA1c was found to be the strongest predictor (Log Coeff. 0.62) for odds of medication change, while number of medications in use was most important for tree based classification. Discharge to another unit in same hospital was the strongest predictor (Log Coeff. 2.37) for odds of 30-day readmission, while time spent in hospital and age of patient were most important in tree classification. For predicting medication change, logistic regression performed similar to decision tree and random forest (64% accuracy, 44% recall), whereas for predicting readmission, 94% accuracy and 90% recall was achieved with random forest using gini function. American hospitals spent over $41 billion on diabetic patients in 2011 who got readmitted within 30 days of discharge [1]. Researchers have attempted to find predictors of readmission rate [2] and among other factors, medication change upon admission has also been shown to be associated with lower readmission rates [3]. Medication change here refers to a change in glucose lowering therapy (typically intensification of insulin therapy) upon admission, which is now included in American Diabetes Associations (ADA) guidelines. [4] Official recommendations from ADA suggesting that intravenous insulin therapy should Continue reading >>

Hospital Readmission Of Patients With Diabetes

Hospital Readmission Of Patients With Diabetes

Hospital Readmission of Patients with Diabetes Hospital Management of Diabetes (GE Umpierrez, Section Editor) Topical Collection on Hospital Management of Diabetes Hospital readmission is a high-priority health care quality measure and target for cost reduction. Despite broad interest in readmission, relatively little research has focused on patients with diabetes. The burden of diabetes among hospitalized patients, however, is substantial, growing, and costly, and readmissions contribute a significant portion of this burden. Reducing readmission rates of diabetic patients has the potential to greatly reduce health care costs while simultaneously improving care. Risk factors for readmission in this population include lower socioeconomic status, racial/ethnic minority, comorbidity burden, public insurance, emergent or urgent admission, and a history of recent prior hospitalization. Hospitalized patients with diabetes may be at higher risk of readmission than those without diabetes. Potential ways to reduce readmission risk are inpatient education, specialty care, better discharge instructions, coordination of care, and post-discharge support. More studies are needed to test the effect of these interventions on the readmission rates of patients with diabetes. Hospital readmissionInpatient diabetesTransitional careTransitions of careRisk factorsDischarge support This article is part of the Topical Collection on Hospital Management of Diabetes A correction to this article is available online at . This is a preview of subscription content, log in to check access Daniel J. Rubin has received grant support from Merck for a subcontract for inpatient diabetes research. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal su Continue reading >>

Taking Steps In The Hospital To Prevent Diabetes-related Readmissions

Taking Steps In The Hospital To Prevent Diabetes-related Readmissions

Taking steps in the hospital to prevent diabetes-related readmissions Author: Scott J. Saccomano, PhD, GNP-BC, RN Despite the growth in scientific advances in management, diabetes continues to be a chronic disease plagued by frequent hospital readmissions. Patients with diabetes account for approximately 480,958 hospital in-patient stays per year with a 30-day readmission rate of 97,784, accounting for a 20.3% hospital readmission rate. Given these statistics, its not surprising that reducing readmission rates for patients with diabetes has become an important goal for hospitals and healthcare providers. And, given the number of people who will be diagnosed with diabetes in the future, emphasis on that goal is only likely to increase. Consider that currently 26 million people in the United States (8.3% of the population) have diabetes, and another 7 million people have undiagnosed diabetes. Estimates indicate an additional 2 million people 20 years and older are diagnosed with diabetes each year. Finally, estimates of people at risk for diabetes or people with pre-diabetes are approximately 79 million. As a nurse, you play a pivotal role in reducing readmission rates by participating in team initiatives related to patient education and self-management and by ensuring that preventing readmissions is addressed early during the hospital stay. Preventing diabetes-related hospital readmissions takes a multidisciplinary team that includes registered nurses, nurse practitioners, physicians, physician assistants, registered dietitians, pharmacists, social workers, nursing assistants, and certified diabetes educators (CDEs). (See About certified diabetes educators.) The team helps educate patients, serves as a resource to staff, and collaborates with other healthcare providers. Continue reading >>

Correction To: Hospital Readmission Of Patients With Diabetes

Correction To: Hospital Readmission Of Patients With Diabetes

Correction to: Hospital Readmission of Patients with Diabetes This article was originally published with errors that were introduced during the editing process. The corrected version of this article appears below. Abstract Hospital readmission is a high-priority health care quality measure and target for cost reduction. Despite broad interest in readmission, relatively little research has focused on patients with diabetes. The burden of diabetes among hospitalized patients, however, is substantial, growing, and costly, and readmissions contribute a significant portion of this burden. Reducing readmission rates of diabetic patients has the potential to greatly reduce health care costs while simultaneously improving care. Risk factors for readmission in this population include lower socioeconomic status, racial/ethnic minority, comorbidity burden, public insurance, emergent or urgent admission, and a history of recent prior hospitalization. Hospitalized patients with diabetes may be at higher risk of readmission than those without diabetes. Potential ways to reduce readmission risk are inpatient education, specialty care, better discharge instructions, coordination of care, and post-discharge support. More studies are needed to test the effect of these interventions on the readmission rates of patients with diabetes. Keywords Hospital readmission Inpatient diabetes Transitional care Transitions of care Risk factors Discharge support Hospital readmission is a high-priority health care quality measure and target for cost reduction, particularly within 30 days of discharge (30-day readmission, aka early readmission) [ 1 , 2 , 3 ]. Despite the broad interest in readmission, relatively little research has focused specifically on readmission of patients with diabetes [ 4 , 5 , Continue reading >>

Mastery In Diabetes Management: Hba1c's Role In Diabetes Readmission

Mastery In Diabetes Management: Hba1c's Role In Diabetes Readmission

Mastery in Diabetes Management: HbA1c's Role in Diabetes Readmission Hirva Bakeri, MD, MS, on how HbA1c levels were not predictive of 30-day hospital readmissions Patients with a primary diagnosis of diabetes were found to have significantly higher HbA1c levels than those with a secondary diagnosis of diabetes. Note that patients with multiple readmissions within 30 days had a higher HbA1c when compared to those with one readmission. Hirva Bakeri, MD, MS, of the University of Connecticut, spoke with MedPage Today at ENDO 2017, the annual meeting of The Endocrine Society in April, when she presented a poster on how mean HbA1c was higher among patients with multiple readmissions compared to those with only 1-readmission, despite HbA1c levels not being significantly associated with overall readmission. Her full poster may be downloaded by clicking here . Following is a transcript of her remarks: The research that we did was about the role of hemoglobin A1c on readmission rates for patients with diabetes. To give you a little bit of background, hospital readmission is a high-priority healthcare quality measure and a target for cost reduction. In this current era of major healthcare reform, this is of growing importance. In 2012, in the month of October, the Centers for Medicare and Medicaid Services came up with a program called Hospital Readmission Reduction program that decreases payments for hospitals if they have higher-than-expected numbers of readmissions. And when I say readmissions, I'm usually talking about early readmissions of patients who were discharged within 30 days and are readmitted within 30 days of discharge. So, what's important to realize is that a large proportion of the hospital expenditure, of this expenditure, is coming from a small percentage of p Continue reading >>

The Relationship Between Diabetes Mellitus And 30-day Readmission Rates

The Relationship Between Diabetes Mellitus And 30-day Readmission Rates

It is estimated that 9.3% of the population in the United States have diabetes mellitus (DM), 28% of which are undiagnosed. The high prevalence of DM makes it a common comorbid condition in hospitalized patients. In recent years, government agencies and healthcare systems have increasingly focused on 30-day readmission rates to determine the complexity of their patient populations and to improve quality. Thirty-day readmission rates for hospitalized patients with DM are reported to be between 14.4 and 22.7%, much higher than the rate for all hospitalized patients (8.513.5%). The objectives of this study were to (1) determine the incidence and causes of 30-day readmission rates for patients with diabetes listed as either the primary reason for the index admission or with diabetes listed as a secondary diagnosis compared to those without DM and (2) evaluate the impact on readmission of two specialized inpatient DM services: the Hyperglycemic Intensive Insulin Program (HIIP) and Endocrine Consults (ENDO). For this study, DM was defined as any ICD-9 discharge diagnosis (principal or secondary) of 250.xx. Readmissions were defined as any unscheduled inpatient admission, emergency department (ED) visit, or observation unit stay. We analyzed two separate sets of patient data. The first pilot study was a retrospective chart review of all patients with a principle or secondary admission diagnosis of diabetes admitted to any adult service within the University of Michigan Health System (UMHS) between October 1, 2013 and December 31, 2013. We then did further uncontrolled analysis of the patients with a principal admitting diagnosis of diabetes. The second larger retrospective study included all adults discharged from UMHS between October 1, 2013 and September 30, 2014 with princ Continue reading >>

Inpatient Diabetes Education Reduces Readmissions Rate

Inpatient Diabetes Education Reduces Readmissions Rate

Inpatient Diabetes Education Reduces Readmissions Rate Inpatient diabetes education was associated with 34% reduced risk of all-cause readmissions within 30 days, and 20% reduced risk of readmissions at 180 days, after adjustment for other potentially confounding variables, in a retrospective study published in Diabetes Care. Hospital readmission is an important contributor to total medical expenditures and an emerging indicator of quality of care, said Sara J. Healy, MD, endocrinology fellow at Ohio State University Wexner Medical Center in Columbus, Ohio. Hospitals have started to incur penalties for readmission within 30 days for certain conditions and other medical conditions are expected to be added, Dr. Healy said. The objective of the retrospective study was to explore the relationship between inpatient diabetes education, conducted by a dedicated trained diabetes educator, and hospital readmissions in patients with poorly controlled diabetes (A1C>9%) hospitalized between 2008 and 2010, Dr. Healy said. A total of 2,265 patients was included in the 30-day analysis, and 2,069 patients were included in the 180-day analysis. Most of the patients were initially admitted for reasons other than uncontrolled diabetes. Inpatient Diabetes Education Linked to 34% Reduced Risk for Readmission Patients who received inpatient diabetes education (IDE) had a lower frequency of readmission within 30 days than did those who did not (11% vs 16%; P=0.0001), Dr. Healy said. After adjusting for sociodemographic and illness-related factors, IDE was associated with a lower risk for readmission (odds ratio, 0.66; P=0.001). Other independent predictors of readmission included Medicaid insurance and longer hospital stay. The beneficial effect of diabetes education on reduced risk for hosp Continue reading >>

Specialized Diabetes Teams Reduce Hospital Readmissions, Costs

Specialized Diabetes Teams Reduce Hospital Readmissions, Costs

Specialized diabetes teams reduce hospital readmissions, costs Hospitalized patients with diabetes managed by a specialized diabetes team were less likely to be readmitted within 30 days vs. patients managed by a primary service team, according to findings published in BMJ Open Diabetes Research & Care. In most U.S. hospitals, a primary service team that includes hospitalists, internal or family medicine physicians or general surgery physicians is responsible for diabetes management in medical and surgical noncritical care units , Osama Hamdy, MD, PhD, FACE, medical director of the obesity clinical program and director of inpatient diabetes program at Joslin Diabetes Center, Harvard Medical School, and colleagues wrote in the study background. Diabetes management teams typically include an endocrinologist, diabetes nurse practitioner and a dietitian or certified diabetes educator, working together to provide general diabetes education and coordinate a diabetes discharge and transition plan. Approximately 43% of the total diabetes cost, the largest chunk, is related to hospital admission, Hamdy told Endocrine Today. If you look to any hospital at any single day, one out of every three admitted patients has diabetes , and in the ICU, the ratio is close to one in every two. Cutting diabetes-related cost should start with the hospital. We found when a diabetes team of specialists, including an MD, nurse practitioner, a [certified diabetes educator] and discharge team, work together early upon admission, it shortens the length of stay and reduces 30-day readmission to medical wards by 30%, and also significantly improves adherence to follow-up post-admission. It saves millions of dollars to hospitals and health care system.Bansal and colleagues conducted a retrospective cha Continue reading >>

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