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Clinical Care/Education/Nutrition
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
  1. Vivek Bansal1,2,
  2. Adham Mottalib3,
  3. Taranveer K Pawar4,
  4. Noormuhammad Abbasakoor5,
  5. Eunice Chuang6,
  6. Abrar Chaudhry7,
  7. Mahmoud Sakr3,
  8. Robert A Gabbay3,
  9. Osama Hamdy3
  1. 1 Department of Medicine, Beth Israel Deaconess Hospital-Needham, Needham, Massachusetts, USA
  2. 2 Center for Advanced Weight Loss, Hunterdon Healthcare, Clinton, New Jersey, USA
  3. 3 Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Department of Medicine, Lahey Clinic Medical Center, Boston, Massachusetts, USA
  5. 5 Division of Endocrinology, Stanford University Medical Center, Stanford, California, USA
  6. 6 Division of Endocrinology, University of California, San Francisco, California, USA
  7. 7 Department of Medicine, Emory University, Atlanta, Georgia, USA
  1. Correspondence to Dr Osama Hamdy; osama.hamdy{at}joslin.harvard.edu

Abstract

Objective We compared the cost-effectiveness of two inpatient diabetes care models: one offered by a specialized diabetes team (SDT) versus a primary service team (PST).

Research design and methods We retrospectively evaluated 756 hospital admissions of patients with diabetes to non-critical care units over 6 months. Out of 392 patients who met the eligibility criteria, 262 were matched 1:1 based on the mean of the initial four blood glucose (BG) values after admission. Primary outcomes were 30-day readmission rate and frequency, hospital length of stay (LOS) and estimated hospital cost. Secondary outcomes included glycemic control and BG variability.

Results Diabetes complexity and in-hospital complications were significantly higher among patients treated by SDT versus PST. Thirty-day readmission rate to medical services was lower by 30.5% in the SDT group versus the PST group (P<0.001), while 30-day readmission rate to surgical services was 5% higher in the SDT group versus the PST group (P<0.05), but frequency of 30-day readmissions was lower (1.1 vs 1.6 times, P<0.05). LOS in medical services was not different between the two groups, but it was significantly longer in surgical services in SDT (P<0.05). However, LOS was significantly lower in patients who were seen by SDT during the first 24 hours of admission compared with those who were seen after that (4.7 vs 6.1 days, P<0.001). Compliance to follow-up was higher in the SDT group. These changes were translated into considerable cost saving.

Conclusions Inpatient diabetes management by an SDT significantly reduces 30-day readmission rate to medical services, reduces inpatient diabetes cost, and improves transition of care and adherence to follow-up. SDT consultation during the first 24 hours of admission was associated with a significantly shorter hospital LOS.

  • inpatient diabetes management
  • cost effectiveness

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2017-000460

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    Footnotes

    • Contributors VB supervised study conduct and drafted its manuscript. AM contributed to statistical analysis, and reviewed and edited the manuscript. TKP did statistical analysis. NA, EC and AC collected patient data. MS shared in manuscript writing. RAG reviewed and edited the manuscript. OH supervised study conduct, shared in data analysis and edited the manuscript.

    • Funding The study was internally funded.

    • Competing interests OH receives research support from Abbott Nutrition, Novo Nordisk, Intarcia and the National Dairy Council; consults for Merck; and is on the advisory board of AstraZeneca. RAG consults for Onduo.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval The study protocol was approved by the medical center’s internal review board (Committee on Clinical Investigations, Beth Israel Deaconess Medical Center).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.