Inpatient Diabetes Education Reduces Readmissions
There is an interesting study about inpatient diabetic education and the potential for reducing inpatient readmission. The problem is stated as follows:
Approximately 20% of sampled diabetic patients with an A1C equal to or greater than 9.0, are readmitted within 30 days of their release from the hospital (Healy, Black, Harris, Lorenz, & Dungan, 2013). To put this in perspective:
“People with diabetes are more likely to be hospitalized and to have longer durations of hospital stay than those without diabetes. A recent survey estimated that 22% of all hospital inpatient days were incurred by people with diabetes” (Moghissi et al., 2009).
Note the difference in the two studies, 22% readmission versus 20% readmission. The extra 2% is likely a measurement error or even small different in sample type.
It means that overall if readmission cases could be reduced, the savings could be substantial. However there are limits. First the study only looked at cases where the A1C was 9.0 and greater. Second, not all readmissions are the same. Let’s say that we have two people one is readmitted because of blood sugar errors, and then yes education might have worked to improve this outcome. The second, the patient is readmitted because of a car accident then education would not have any effect.
To take these factors into account, the researchers tracked 2,256 cases in their study (Healy et al., 2013). The used a 180 time frame for in the normal life of a hospital. Researchers ruled out any person with an A1C less than 9.0 and they also ruled out any readmission where patients were not trained during their first stay in the hospital (Healy et al., 2013).
For the group that had education offered by a Certified Diabetic Educator, the rate of readmission was 11% for those who received education and a whopping 16% of those who did not receive said education (Healy et al., 2013).
According to the ADA, patients are most willing and able to be educated about diabetes management. That makes the education more palatable, accessible and according to this study, perhaps my successful for changing habits in the short run at least.
There are of course problems and it is in the basic facts that guide this study. First, it was only studied in people with an A1C of 9 or greater. Let’s hope that most people are not walking around with A1C’s of 9 or greater. Second, the data collection was limited to a single hospital. Perhaps the CDE’s in this hospital are extremely good or there is a Hawthorne effect. If there is such an effect, taking these savings on face value might be a mistake. Finally Moghissi (et. al) found the following:
‘Intervention directed at reducing blood glucose (BG) levels has resulted in improved outcomes in some, but not all, studies. Several recent clinical trials in critically ill patients have reported no reduction in mortality from intensive treatment targeting near-euglycemia versus conventional management targeting BG 180 mg/dl (10.0 mmol/l)” (Moghissi et al., 2009).
Notice CDE education with intensive care patients had almost no effect on recidivism. These people may have the highest (or lowest) Hb1C’s, I could find no information on this phenomenon. Is this an important finding for CDE education? Probably not. Is this an important study overall? Definitely not. Most of us would say that improved education is important, is it important enough for hospitals to hire additional CDE’s to conduct the education? I doubt it. Insurance will be reluctant to pay for it and hospitals will be reluctant to hire them to further restrict admissions. Unless, those hospitals are liable for the financial cost of same issue readmission./ If that happens, there will not be enough CDE’s to hire.
Healy, Sara J., Black, Dawn, Harris, Cara, Lorenz, Andrew, & Dungan, Kathleen M. (2013). Inpatient Diabetes Education Is Associated With Less Frequent Hospital Readmission Among Patients With Poor Glycemic Control. Diabetes Care. doi: 10.2337/dc13-0108
Moghissi, Etie S., Korytkowski, Mary T., DiNardo, Monica, Einhorn, Daniel, Hellman, Richard, Hirsch, Irl B., . . . Umpierrez, Guillermo E. (2009). American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Diabetes Care, 32(6), 1119-1131. doi: 10.2337/dc09-9029