Impact of the Diabetes Inpatient Care and Education (DICE) project on length of stay and mortality.
Aged
Aged, 80 and over
Blood Glucose Self-Monitoring
Critical Pathways
Diabetes Mellitus
/ therapy
Diabetic Foot
/ diagnosis
Female
Glycemic Control
/ methods
Hospital Mortality
Hospitalization
Humans
Hypoglycemia
/ chemically induced
Hypoglycemic Agents
/ therapeutic use
Interrupted Time Series Analysis
Length of Stay
/ statistics & numerical data
Logistic Models
Male
Medical Staff, Hospital
/ education
Middle Aged
Nurse Specialists
Patient Readmission
/ statistics & numerical data
Practice Patterns, Nurses'
Journal
Diabetic medicine : a journal of the British Diabetic Association
ISSN: 1464-5491
Titre abrégé: Diabet Med
Pays: England
ID NLM: 8500858
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
accepted:
01
07
2019
pubmed:
3
7
2019
medline:
26
2
2021
entrez:
3
7
2019
Statut:
ppublish
Résumé
To determine whether the Diabetes Inpatient Care and Education (DICE) programme, a whole-systems approach to managing inpatient diabetes, reduces length of stay, in-hospital mortality and readmissions. Diabetes Inpatient Care and Education initiatives included identification of all diabetes admissions, a novel DICE care-pathway, an online system for prioritizing referrals, use of web-linked glucose meters, an enhanced diabetes team, and novel diabetes training for doctors. Patient administration system data were extracted for people admitted to Ipswich Hospital from January 2008 to June 2016. Logistic regression was used to compare binary outcomes (mortality, 30-day readmissions) 6 months before and after the intervention; generalized estimating equations were used to compare lengths of stay. Interrupted time series analysis was performed over the full 7.5-year period to account for secular trends. Before-and-after analysis revealed a significant reduction in lengths of stay for people with and without diabetes: relative ratios 0.89 (95% CI 0.83, 0.97) and 0.93 (95% CI 0.90, 0.96), respectively; however, in interrupted time series analysis the change in long-term trend for length of stay following the intervention was significant only for people with diabetes (P=0.017 vs P=0.48). Odds ratios for mortality were 0.63 (0.48, 0.82) and 0.81 (0.70, 0.93) in people with and without diabetes, respectively; however, the change in trend was not significant in people with diabetes, while there was an apparent increase in those without diabetes. There was no significant change in 30-day readmissions, but interrupted time series analysis showed a rising trend in both groups. The DICE programme was associated with a shorter length of stay in inpatients with diabetes beyond that observed in people without diabetes.
Substances chimiques
Hypoglycemic Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
277-285Informations de copyright
© 2019 Diabetes UK.
Références
Kanvos P, van den Aardweg S, Schurer W. Diabetes expenditure, burden of disease and management 5 EU countries. LSE Health, London school of Economics, 2012.
NHS Digital. National diabetes inpatient Audit 2011. Available at https://digital.nhs.uk/catalougue/PUB06279. Last accessed 6 February 2017.
NHS Digital. National Diabetes Inpatient Audit (NADiA) 2017. Available at https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-inpatient-audit/national-diabetes-inpatient-audit-nadia-2017. Last accessed 13 September 2018.
Meng YY, Pickett M, Babey SH, Davis AC, Goldstein H. Diabetes tied to a third of California hospital stays, driving health care costs higher. Los Angeles, Los Angeles UCLA Center for Health Policy Research and California Center for Public Health Advocacy, 2014. Available at http://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=1278 Last accessed 27 September 2015.
Kerr M. Inpatient Care for People with Diabetes: The Economic Case for Change. : NHS diabetes, November 2011. Available at https://www.diabetes.org.uk/resources-s3/2017-10/Inpatient%20Care%20for%20People%20with%20Diabetes%20%20The%20Economic%20Nov%202011_1.pdf. Last accessed 27 September 2015.
American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care 2018; 41: 917-928.
Donze J, Lipsitz S, Bates BW, Schinipper JL. Causes and patterns of readmissions in patients with common comorbidities: retrospecitve cohort study. BMJ 2013; 347: f7171.
Sampson MJ, Dozio N, Ferguson B, Dhatariya K. Total and excess bed occupancy by age, speciality and insulin use for nearly one million diabetes patients discharged from all English Acute Hospitals. Diabetes Res Clin Pract 2007; 1: 92-98.
Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM et al. Endocrine Society. Management of hyperglycaemia in hosptialized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocroniol Metab 2013; 97: 16-38.
Holman N, Hilson R, Young RK. Excess mortality during hosptial stays among patients with recorded diabetes compared with those without diabetes. Diabet Med 2013; 30: 1393-1402.
Pomposelli JJ, Baxter JK, Baineau TJ. Early Postoperative Glucose Control Predicts Nosocomial Infection Rate in Diabetic Patients. JPEN J Parenter Enteral Nutr 1998; 22: 77-81.
Nirantharakumar K, Marshall T, Kennedy A, Narendran P, Hemming K, Coleman JJ. Hypoglycaemia is associated with increased length of stay and mortality in people with diabetes who are hosptialized. Diabet Med 2012; 29: e445-e448.
Thomas JW, Guire KE, Horvat GG. Is patient length of stay related to quality of care? Hosp Health Serv Adm 1997; 42: 489-507.
Glickman SW, Boulding W, Manary M, Staelin R. Patient Satisfaction and Its Relationship With Clinical Quality and Inpatient mortality in myocardial infarction. Circ Cardiovasc Qual Outcomes 2010; 3: 188-195.
NHS Institute for Innovation and Improvement. Quality and Productivity case study. NICE, 2013. Available at https://www.nice.org.uk/savingsandproductivityandlocalpracticeresource?xml:id=2627. Last accessed 3 July 2018.
Davies M, Dixon S, Currie CJ, Davis RE, Peers JR. Evaluation of a hospital diabetes specialist nursing service:a randomised controlled trial. Diabet Med 2001; 18: 301-307.
Flanagan D, Moore E, Baker S, Wright D. Diabetes care in hospital- the impatct of a dedicated diabetes inpatient team. Diabet Med 2008; 25: 147-151.
Biglan A, Ary D, Wagenaar AC. The value of interrupted time-series experiments for community intervention research. Prev Sci 2000; 1: 31-49.
Lagarde M. How to do (or not to do)..Assessing the impact of a policy change with routine longitudinal data. Health Policy Plan 2011; 27: 76-83.
Rayman G, Vas P, Baker N, Taylor C. A simple and novel method to identify patients with diabetes at risk of foot ulceration. Diabetes Care 2011; 34: 1517-1518.
Rajendran R, Raound RM, Kerry C, Barker S, Rayman G. Diabetes patient at risk score- a novel sstem for triaging approriate referrals or inpatients with diabetes to the diabetes team. Clin Med (London) 2015; 15: 229-233.
Taylor CG, Morris C, Rayman G. An interactive 1 hour educational programme for junior doctors increases their confidence and improves inpatient diabetes care. Diabet Med 2012; 1574-1578.
Ostling S, Wyckoff J, Ciarkowski SL, Pai CW, Choe HM, Bahl V et al. The relationship between diabetes mellitus and 30-day readmission rates. Clin Diabetes Endocrinol 2017; 3: 3.
Krinsley JS, Maurer P, Holewinski S, Hayes R, McComsey D, Umpierrez GE et al. Glucose Control, Diabetes Status, and Mortality in Critically Ill Patients: The Continuum From Intensive Care Unit Admission to Hospital Discharge. Mayo Clin Proc 2017; 92: 1019-1029.
Koproski J, Pretto Z, Poretsky L. Effects of an intervention by a diabetes team in hospitalized patients with diabetes. Diabetes Care 1997; 20: 1553-1555.
Bansal V, Mottalib A, Pawar TK, Abbasakoor N, Chuang E, Chaudhry A et al. Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost. BMJ Open Diabetes Res Care 2018; 6: e000460.
NHS right care. RightCare scenario:The variation between standard and optimal pathways. NHS England, 2016. Available at https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2016/08/janet-story-narr.pdf. Last accessed 13 September 2018.
MacBride-Stewart S, Marwick C, Houston N, Watt I, Patton A, Guthrie B. Evaluation of a complex intervention to improve primary care prescribing: a phase IV segmented regression interrupted time series analysis. Br J Gen Pract 2017; 67: e352-e360.