Table 2.
Strategies to prevent acute care re-utilization
| Name, author, date | Population | Study type | Sample size | Baseline or control readmission riska | Post intervention readmission risk, RRR/RRIb | Intervention component |
|---|---|---|---|---|---|---|
| Inpatient Diabetes Education | ||||||
| Davies, 2001 [69] | Admitted patients with diagnosis of diabetes referred for education | RCT |
N = 300 Int.: 148 Control: 152 |
1-year: 25% | 1-year: 25% | Inpatient diabetes education by diabetes specialist nurse |
| Healy, 2013 [53••] | Adults with A1c>9% and discharge diagnosis of diabetes | Retrospective cohort |
30 days N = 2265 180 days N = 2069 |
30-day: 16% 180-day: 45% |
30-day: 11% (P = 0.0001), RRR 31.3%* 180-day: 37% (P = 0.002), RRR 17.8%* |
Inpatient diabetes education by diabetes educator |
| Corl, 2015 [54] | Inpatient hyperglycemia (>180 mg/dl), length of stay 2-9 days, and preexisting diabetes and/or inpatient insulin treatment | Retrospective cohort |
N = 254 Int.: 202 Control: 52 |
7-day: 6.2% 14-day: 9.2% 30-day: 13.0% |
7-day 2.5% (P = 0.004), RRR 59.7%* 14-day: 5.7 (P = 0.335) 30-day: 11.9 (P = 0.557) |
Inpatient diabetes education by staff nurse |
| Murphy, 2019 [55] | Hospitalized adults with a diagnosis of diabetes, a blood glucose >200 mg/dL on admission, and/or hemoglobin A1C >6.5% | Retrospective cohort |
Int.: 264 Control: 149 |
30-day: 21.5% | 30-day: 13.2% (P = 0.023)*, RRR 62.9% | Inpatient diabetes education by pharmacist or student pharmacist |
| Inpatient diabetes management service | ||||||
| Koproski, 1997 [56] | Admitted patients with diagnosis of diabetes | RCT |
N = 197 Int.: 85 Control: 94 |
90-day: 32% | 90-day: 15% (P = 0.01), RRR 53.1%* | Co-management by IDMS (endocrinologist, nurse, and certified diabetes educator) |
| Wang, 2016 [57] |
Patients with T2D admitted for infection or cardiac-related diagnoses Subgroup with mean BG >180 mg/dl |
Retrospective cohort |
N = 440 Int.: 91 Control: 349 Subgroup n = 116 Int.: 33 Control: 83 |
30-day: not reported Subgroup 30-day: 28.9% |
30-day: not reported, P > 0.05 Subgroup 30-day: 9.1% (P < 0.02)c, RRR 68.5%* |
Co-management by IDMS (endocrinologist and advanced practice provider) |
| Bansal, 2018 [58] | Patients with diabetes admitted to noncritical units at a single tertiary referral medical center | Retrospective cohort |
N = 262 Int.: 131 Control: 131 |
Non-surgical 30-day: 32.4% Surgical 30-day: 21.7% |
Non-surgical 30-day: 22.5% (P < 0.001), RRR 30.6%* Surgical 30-day: 26.7% (P > 0.05) |
Co-management by IDMS (endocrinologist, diabetes NP, nurse diabetes educator, and a discharge coordinator) |
| Mandel, 2019 [59] | Patients admitted with glucose <60 or >250 mg/dl, uncontrolled diabetes with recent cardiac surgery, high dose glucocorticoids, new T1D with DKAd, or insulin pump | Retrospective cohort |
N = 4650 Int.: 850 Control: 3804 |
30-day: 25% | 30-day: 14.2% (P = 0.048), RRR 43.2%* | Co-management by IDMS (endocrinologist, NP, and diabetes educator) |
| Multi-component transition of care program | ||||||
| Transitional Care Clinic, Seggelke, 2014 [60] | Patients with T2D who are medically indigent (no insurance or Medicaid without PCPe) | Pilot RCT |
N = 100 Int.: 50 Control: 50 Subgroup admitted for DM n = 30 Int.: 16 Control: 14 |
90-day: 28% Subgroup 90-day: 42.9% |
90-day: 20% (P not significant) Subgroup 90-day: 12.5%, (P < 0.05), RRR 70.9%* |
TCC visit 2 to 5 days after discharge for medication adjustment by endocrinologist, NP, or PAf |
| Sweet Transitions, Berger, 2018 [61] | Patients with poorly controlled diabetes (A1c>9%) | Prospective non-randomized trial with matched controls | Int.g: 197 patients | 30-day: 17% | 30-day: 11% (P = 0.08) | Individualized post-discharge care coordination and education, barrier identification, medication adjustment by NP h and diabetes educator, transfer of care plan to outpatient clinician |
| Diabetes transition program, Brumm, 2016 [62] | Veterans with poorly controlled diabetes (A1c≥9%) and psychosocial challenges (cognitive disorders, depression, living alone, insulin-naïve, finances, or new diagnosis) | Retrospective pre- and post-intervention |
Int.: 40 Control: historical, sample unspecified |
30-day: 14.3% | 30-day: 10% | Hospital visit by the NP-inpatient diabetes educator, weekly phone calls after discharge, 24/7 access to nurse hotline |
| Magny-Normilus, 2021 [63] | Adults with T2Di admitted to medicine or cardiovascular units with active CVDj, and prescribed insulin before admission or likely to be prescribed insulin at discharge. | RCT |
N = 180 Int.: 88 Control: 92 usual care |
30-day: 14.1% 30-day ED: 9.1%k |
30-day: 20.5%, RRI 46.1% 30-day ED: 9.8% (P=0.87) |
Inpatient pharmacist counseling, visiting nurse home evaluations, symptom screening phone calls and after-hospital care planning by NP, follow-up in post-discharge clinic within 3 days, telemonitoring of glucose, follow-up with PCP or endocrinologist within 1 week of discharge |
| Pharmacy coordination, Wright, 2019 [64] | Adults with discharge diagnosis for heart failure, acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, or diabetes (75% had DM) | Prospective pragmatic interventional study with 5:1 matched controls |
Int.: 187 Control: 935 |
30-day: 15% 30-day ED: 22% |
30-day: 9% (P = 0.02), RRR 40%* 30-day ED: 20% (P = 0.48) |
Coordination between inpatient and outpatient pharmacist |
| Diabetes Transition of Hospital Care (DiaTOHC), Rubin [65], 2020 [66] | Diabetes and high risk of 30-day readmission (≥27%) based on DERRI | Pilot RCT |
N = 91 Int.: 46 Control: 45 Subgroup with A1c>7% N = 69 |
30-day readmission or ED: 39.1% 90-day: 50% 90-day readmission or ED: 60.0% A1c>7% Subgroup 30-day readmission or ED visit: 40% |
30-day readmission or ED: 31.8% 90-day: 46.7% 90-day readmission or ED: 52.9% A1c>7% Subgroup 30-day readmission or ED: 26.5% (P = 0.23) |
Focused inpatient diabetes education, coordination of care, physician titration of diabetes therapy upon discharge based on A1c algorithm, and post-discharge phone calls by NP until 30 days after discharge |
| Multidisciplinary diabetes clinic, Bhalodkar, 2020 [27] | Adults admitted to medicine service with diagnosis of diabetes | RCT |
N = 192 Int.: 97 Control: 95 |
30-day readmission or ED: 19% 1-year readmission or ED: 38% |
30-day readmission or ED: 7% (P = 0.02), RRR 63.2%* 1-year readmission or ED: 14% (P < 0.01), RRR 63.2%* |
Outpatient visit with diabetes educator/NP, subsequent outpatient visits with NP, nutritionist, social worker or endocrinologist as needed |
*Statistically significant at P < 0.05
aOutcome is for readmission unless otherwise noted
b Relative risk reduction or relative risk increase; P value included if reported
cP value for composite outcome, individual outcome P value was not reported
dDiabetic ketoacidosis
ePrimary care provider
fPhysician assistant
gIntervention
hNurse practitioner
iType 2 diabetes
jCardiovascular disease
kPrimary outcome was diabetes medication adherence during the 90 days after discharge