Inpatient to Outpatient Transfer of Diabetes Care: Planning for an Effective Hospital Discharge

Cook, Curtiss B.; Seifert, Karen M.; Hull, Bryan P.; Hovan, Michael J.; Charles, Joseph C.; Miller-Cage, Victoria; Boyle, Mary E.; Harris, Jana K.; Magallanez, Jan M.; Littman, Stephanie D.

doi:10.4158/ep.15.3.263

Cited by 58 publications

(43 citation statements)

References 28 publications

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“…Education is ideally delivered over multiple visits, and therefore, early identification of patient needs and appropriate consultation is desirable. 53 Where certified diabetes educators are unavailable, diabetes nurse champions can be trained on each unit to facilitate education efforts. In the outpatient setting, nursing education has resulted in improved HbA1c and adherence to medication and glucose monitoring, so the potential benefits are not limited to readmission.…”

Section: Inpatient Glycemic Management Teamsmentioning

confidence: 99%

The Effect of Diabetes on Hospital Readmissions

Dungan

2012

J Diabetes Sci Technol

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Abbreviations: (CHF) congestive heart failure, (DKA) diabetic ketoacidosis, (HbA1c) hemoglobin A1cKeywords: glycemic control, hemoglobin A1c, hospital, inpatient, readmission, rehospitalization AbstractHospital readmission is an important contributor to total medical expenditures and is an emerging indicator of quality of care. Diabetes, similar to other chronic medical conditions, is associated with increased risk of hospital readmission. Risk factors include previous hospitalization, extremes in age, and socioeconomic barriers. Preliminary studies suggest that acute and/or chronic glycemic control may be of importance when diabetes is the primary diagnosis or when it is a comorbidity. Very limited evidence from prospective randomized controlled trials aimed at improving glycemic control is available. However, whether one concludes that inpatient or outpatient glycemic control is partly responsible for reduced hospitalizations, attention to glycemic control in the hospital may facilitate sustained glycemic control post-discharge. Limited prospective and retrospective evidence suggest that the involvement of a diabetes specialist team may improve readmission rates, but attention to more generalized comprehensive approaches may also be worthwhile. Prospective interventional studies targeting interventions for improving glycemic control are needed to determine whether glycemic control impacts readmission rates.

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Section: Inpatient Glycemic Management Teamsmentioning

confidence: 99%

The Effect of Diabetes on Hospital Readmissions

Dungan

2012

J Diabetes Sci Technol

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“…Other matters, such as patient and staff education and transition of care (e.g., from the inpatient to the outpatient setting) 12 are also important. Nonetheless, assessment of inpatient glucose control remains of prime interest.…”

Section: Introductionmentioning

confidence: 99%

Assessing Inpatient Glycemic Control: What are the Next Steps?

Cook¹,

Wellik

Kongable

et al. 2012

J Diabetes Sci Technol

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Abbreviations: (POC-BG) AbstractDespite the emergence of glucometrics (i.e., systematic analysis of data on blood glucose levels of inpatients) as a subject of high interest, there remains a lack of standardization on how glucose parameters are measured and reported. This dilemma must be resolved before a national benchmarking process can be developed that will allow institutions to track and compare inpatient glucose control performance against established guidelines and that can also be supported by quality care organizations. In this article, we review some of the questions that need to be resolved through consensus and review of the evidence, and discuss some of the limitations in analyzing and reporting inpatient glucose data that must be addressed (or at least accepted as limitations) before hospitals can commit resources to gathering, compiling, and presenting inpatient glucose statistics as a health care quality measure. Standards must include consensus on which measures to report, the unit of analysis, definitions of targets for hyperglycemia treatment, a definition of hypoglycemia, determination of how data should be gathered (from chart review or from laboratory information systems), and which type of sample (blood or point of care) should be used for analysis of glycemic control. Hospitals and/or their representatives should be included in the discussion. For inpatient glucose control to remain a focus of interest, further dialogue and consensus on the topic are needed.

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“…La consecuencia de todo ello es que se está asistiendo a una elevada tasa de insulinizació n al alta y, probablemente, a un exceso de pautas de insulina complejas. Por tanto, tal como reconocen la American Association of Clinical Endocrinologists y la American Diabetes Association, la adecuada planificació n del alta hospitalaria debe formar parte del tratamiento integral del paciente con diabetes 6,47 . La American Diabetes Association 6 considera que un plan de alta adecuado debe incluir los siguientes aspectos: a) realizar una «conciliació n de los medicamentos» para asegurar que la medicació n habitual del paciente no se haya suspendido, así como la seguridad y compatibilidad de los nuevos medicamentos prescritos; b) efectuar una comunicació n estructurada del alta, informando de manera segura y rá pida a los equipos de Atenció n Primaria de los cambios terapé uticos efectuados, las pruebas complementarias pendientes y las necesidades futuras de seguimiento; c) es recomendable que todos los pacientes con hiperglucemia hospitalaria sean revisados en el mes posterior al alta por el equipo de Atenció n Primaria o especializada, y d) para evitar vacíos asistenciales, es importante que se suministre a los pacientes el equipamiento necesario para realizar el tratamiento y se les instruya en los aspectos esenciales para el manejo seguro.…”

Section: Relevancia De La Diabetes En El Medio Hospitalariounclassified