School of Medicine and Health Sciences Poster Presentations

Title

Outpatient Follow-up as Predictor of Readmission Rates and Glucose Control in Patients Hospitalized for Diabetes

Poster Number

194

Document Type

Poster

Publication Date

3-2016

Abstract

Background: Diabetes is a chronic disease with increasing prevalence. We hypothesize that a significant percent of patients with a primary diagnosis of diabetes/diabetes-related complications after hospitalization at George Washington University Hospital (GWUH) would have no specific follow-up and overall glucose control would be poor after discharge.

Methods: This is a retrospective study evaluating the rate of follow-up for diabetes after hospitalization at GWUH for a primary diagnosis of diabetes/diabetes-related complications. There were 4266 GWUH admissions with a primary/secondary diagnosis of diabetes from June 2014 to June 2015. Chart review of patients (289) with a hospital admission for a primary diagnosis of diabetes/diabetes-related complications was conducted with assessment of readmission rates and overall glucose control after discharge. Discharge instructions/summaries from the hospital were reviewed for instructions/arranged appointments for follow-up. Follow-up rate was evaluated. Hemoglobin A1c during admission or within 180 days of admission as well as 90-180 days post-admissions were assessed. Hospital readmission rates were assessed at 30, 60, 90, and 180 days.

Results: The readmission rate for a primary diagnosis of diabetes was 7.27% at 30 days and 28.02% at 90 days while overall readmissions for any cause at 30 days was 15.2% and at 90 days was 30.1%. 78.9% patients had A1c within 180 days of admissions/during admission. 21.8% had A1c > 10% and 21.5% >8%. Concerning follow-up, 71.47% had directions to follow-up with primary care providers. 67.08% patients has follow-up arranged with primary care providers prior to discharge; 40% of those that had follow-up arranged actually followed up compared to 17% that actually followed up when follow-up was not arranged (P = .0036). Of the 319 patients, 200 had follow up. Hemoglobin A1c within 90-180 days after admission. A1c was >10% for 37.1% and 59.6% for >8%.

Discussion: Although limited by the review at a single institution in a metropolitan center with multiple health care systems, our data showed a significant percent of patients with a primary diagnosis of diabetes/diabetes-related complications were re-admitted, often did not have specific follow-up or complete follow-up as instructed, and overall glucose control remained poor following admission.

Conclusion: To improve long term health outcomes in hospitalized patients with diabetes, protocols to ensure follow-up need to be implemented.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at: GW Research Days 2016

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Outpatient Follow-up as Predictor of Readmission Rates and Glucose Control in Patients Hospitalized for Diabetes

Background: Diabetes is a chronic disease with increasing prevalence. We hypothesize that a significant percent of patients with a primary diagnosis of diabetes/diabetes-related complications after hospitalization at George Washington University Hospital (GWUH) would have no specific follow-up and overall glucose control would be poor after discharge.

Methods: This is a retrospective study evaluating the rate of follow-up for diabetes after hospitalization at GWUH for a primary diagnosis of diabetes/diabetes-related complications. There were 4266 GWUH admissions with a primary/secondary diagnosis of diabetes from June 2014 to June 2015. Chart review of patients (289) with a hospital admission for a primary diagnosis of diabetes/diabetes-related complications was conducted with assessment of readmission rates and overall glucose control after discharge. Discharge instructions/summaries from the hospital were reviewed for instructions/arranged appointments for follow-up. Follow-up rate was evaluated. Hemoglobin A1c during admission or within 180 days of admission as well as 90-180 days post-admissions were assessed. Hospital readmission rates were assessed at 30, 60, 90, and 180 days.

Results: The readmission rate for a primary diagnosis of diabetes was 7.27% at 30 days and 28.02% at 90 days while overall readmissions for any cause at 30 days was 15.2% and at 90 days was 30.1%. 78.9% patients had A1c within 180 days of admissions/during admission. 21.8% had A1c > 10% and 21.5% >8%. Concerning follow-up, 71.47% had directions to follow-up with primary care providers. 67.08% patients has follow-up arranged with primary care providers prior to discharge; 40% of those that had follow-up arranged actually followed up compared to 17% that actually followed up when follow-up was not arranged (P = .0036). Of the 319 patients, 200 had follow up. Hemoglobin A1c within 90-180 days after admission. A1c was >10% for 37.1% and 59.6% for >8%.

Discussion: Although limited by the review at a single institution in a metropolitan center with multiple health care systems, our data showed a significant percent of patients with a primary diagnosis of diabetes/diabetes-related complications were re-admitted, often did not have specific follow-up or complete follow-up as instructed, and overall glucose control remained poor following admission.

Conclusion: To improve long term health outcomes in hospitalized patients with diabetes, protocols to ensure follow-up need to be implemented.