Heart failure and frequent hospitalization can increase risk of readmission among diabetes patients.
New cases of diabetes have been increasing around the world, placing a significant health and financial burden on patients. If patients do not achieve disease control through diet, exercise, and prescription drugs, they may face hospitalization.
Identifying factors that may impact inpatient care for patients with diabetes can play a role in driving down costs, according to a study published by The Medical Journal of Australia.
In the United States, approximately 30% of patients with diabetes have been admitted to the hospital at least 2 times in the previous year, and accounted for a significant proportion of medical spending. In Australia, 85% of patients hospitalized for diabetes are elderly.
Another significant driver of diabetes spending is the high rate of hospital readmission, which suggests poor care coordination and discharge planning. By understanding what factors could play a role in readmission, high risk patients can be more effectively managed.
Included in the study were 848 patients hospitalized for diabetes included in the Department of Veterans Affairs database. The study authors looked at factors that may be involved with readmission, including age, sex, geographic location, length of initial stay, comorbidities, medication, primary care visits, and prescribers.
Approximately 24.6% of patients were readmitted to the hospital within 30 days of initial hospitalization, according to the study.
Of those patients, 24% of patients were admitted due to a diabetes-related condition, such as foot ulcer or hyperglycemia/hypoglycemia. An additional 21% were hospitalized because of cardiovascular conditions, while a smaller percentage of patients were admitted for other reasons.
The study authors discovered that 40.7% of the observed hospitalizations were potentially avoidable. Approximately 88% of avoidable readmissions were for chronic conditions, according to the study.
The researchers noted that a large number of patients with 7 or more comorbidities were re-hospitalized. A higher number of general practitioner (GP) visits were also common among readmitted patients, according to the study.
Conditions, such as heart failure and end-stage renal disease, were significantly higher among readmitted patients. Additionally, 23.4% of readmitted patients experienced 2 or more hospitalizations prior to the index admission, compared with 14.9% of patients not readmitted, according to the study.
The authors discovered that an overwhelming 77.5% of patients were readmitted within 14 days of initial hospitalization.
The investigators identified that heart failure, recent hospitalizations, and multiple prescribers all impacted readmission.
“Proactive identification of patients at higher risk may facilitate preventive actions, including organising [sic] GP visits 1 to 2 weeks after discharge, particularly for patients who have had a recent prior hospitalisation [sic] and who have more than one medical practitioner prescribing their medicines,” the authors wrote.
With a nearly half of readmission cases potentially preventable, these findings underscore the need of care coordination between the hospital team and the patient’s GP. Although preventing re-hospitalization may not be possible in all cases, a better understanding of the factors that influence risk could improve care.
“While hospital readmissions are a multifaceted problem, our findings highlight the need for improved care transitions and coordination of care to reduce this significant burden on both patients and the Australian health care system,” the authors wrote. “Readmissions are expensive, demanding on health care resources, and pose a significant risk to patient safety.”