Evaluating the effect of inpatient diabetes education on length of stay, readmission rates and mortality rates: a systematic review

Zeeshan Hussain, Mohammed Alkharaiji, Iskandar Idris

Abstract


Background: Hospitalised patients with diabetes experience a longer duration of inpatient stay, increased readmission rates and excess mortality compared with patients without diabetes.

Objectives: To determine whether inpatient diabetes education (IDE), provided to hospitalised patients with diabetes, is an effective intervention in improving one or all of the following clinical outcomes: length of stay (LOS), readmission rate and mortality rate.

Methods: A free-text search on MEDLINE, PubMed, CINAHL, BNI and EMBASE was conducted on literature published from the date of each databases’ inception to March 2019. In addition, grey literature was used to support the search with the following key terms: ‘IDE’, ‘LOS’, ‘readmission’ and ‘mortality’, along with their possible substitutes and alternatives combined.

Results: In total, eight studies met the inclusion criteria with a total number of 3,828 participants. Seven studies investigated LOS outcome for which accumulated mean LOS and median LOS were both lower (16.5% and 26.67%, respectively) in the IDE group compared with the non-IDE group. Six studies investigated readmittance rates, for which accumulated readmission rate (up to 12 months) was 15.9% lower in the IDE group than in the non-IDE group. Finally, the mortality rate was 36.6% lower in the IDE group compared with the non-IDE group, but this was non-significant and only one study reported this outcome.

Conclusion: The findings of this review support the efficacy of an IDE programme in a hospital setting by reducing LOS and readmission rates in patients with diabetes. In addition, a possible trend towards a decreased mortality rate was observed. IDE is therefore recommended to improve clinical outcomes of hospitalised patients with diabetes.


Keywords


inpatient diabetes, education, length of stay, readmission rate, mortality, systematic review

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References


Diabetes UK (2018). Diabetes prevalence 2018. Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics/diabetes-prevalence-2018 (accessed April 2019).

Jiang HJ, Stryer D, Friedman B, Andrews R. Multiple hospitalizations for patients with diabetes. Diabetes Care 2003; 26(5):1421–6. https://doi.org/10.2337/diacare.26.5.1421

Comino EJ, Harris MF, Islam MD, et al. Impact of diabetes on hospital admission and length of stay among a general population aged 45 years or more: a record linkage study. BMC Health Services Res 2015;15(1):1–13. https://doi.org/10.1186/s12913-014-0666-2

Ostling S, Wyckoff J, Ciarkowski SL, et al. The relationship between diabetes mellitus and 30-day readmission rates. Clin Diabetes Endocrinol 2017;3(3). https://doi.org/10.1186/s40842-016-0040-x

Zapatero A, Gomez HR, Gonzalez N, et al. Frequency of hypoglycemia and its impact on length of stay, mortality, and short-term readmission in patients with diabetes hospitalized in internal medicine wards. Endocrine Pract 2014;20(9):870–5. https://doi.org/10.4158/EP14006.OR

Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002;87(3):978–82. https://doi.org/10.1210/jcem.87.3.8341

Diabetes UK (2017). Inpatient care for people with diabetes. Available at: https://www.diabetes.org.uk/professionals/position-statements-reports/specialist-care-for-children-and-adults-and-complications/inpatient-care-for-people-with-diabetes (accessed April 2019).

Diabetes UK (2019). Cost of diabetes. Available at: https:// www.diabetes.co.uk/cost-of-diabetes.html (accessed April 2019).

Hardee SG, Osborne KC, Njuguna N, et al. Interdisciplinary diabetes care: a new model for inpatient diabetes education. Diabetes Spectr 2015; 28(4):276–82. https://doi.org/10.2337/diaspect.28.4.276

Young JL. Educating staff nurses on diabetes: knowledge enhancement. Medsurg Nurs 2011;20(3):143–6.

Cook C, Seifert KM, Hull BP, et al. Inpatient to outpatient transfer of diabetes care: planning for an effective hospital discharge. Endocr Pract 2009;15(3):263–9. https://doi.org/10.4158/EP.15.3.263

Conway A, Clarke MJ, Treweek S, et al. Summary of findings tables for communicating key findings of systematic reviews. Cochrane Database of Systematic Rev 2017;2:MR000044. https://doi.org/10.1002/14651858.MR000044

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Ann Intern Med 2009;151(4):264–9. https://doi.org/10.7326/0003-4819-151-4-200908180-00135

Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions [Version 5.1.0]. The Cochrane Collaboration. 2011. Available at: http://handbook-5-1.cochrane.org (accessed April 2019).

Corl DE, Guntrum PL, Graf L, et al. Inpatient diabetes education performed by staff nurses decreases readmission rates. AADE in Practice 2015;3(2):18–23.

Davies M, Dixon S, Currie CJ, Davis RE, Peters JR. Evaluation of a hospital diabetes specialist nursing service: a randomized controlled trial. Diabet Med 2001;18(4):301–7. https://doi.org/10.1046/j.1464-5491.2001.00470.x

Flanagan D, Moore E, Baker S, Wright D, Lynch P. Diabetes care in hospital – the impact of a dedicated inpatient care team. Diabet Med 2008; 25(2):147–51. https://doi.org/10.1111/j.1464-5491.2007.02326.x

Healy SJ, Black D, Harris C, Lorenz A, Dungan KM. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care 2013;36(10):2960–7. https://doi.org/10.2337/dc13-0108

Levetan CS, Salas JR, Wilets IF, Zumoff B. Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes. Am J Med 1995;99(1):22–8. https://doi.org/10.1016/s0002-9343(99)80100-4

Murphy JA, Schroeder MN, Ridner AT, et al. Impact of a pharmacy-initiated inpatient diabetes patient education program on 30-day readmission rates. J Pharmacy Pract 2019 Feb 2017;897190019833217. https://doi.org/ https://doi.org/10.1177/0897190019833217

Puig J, Supervia A, Marquez MA, et al. Diabetes team consultation: Impact on length of stay of diabetic patients admitted to a short-stay unit. Diabetes Res Clin Pract 2007;78(2):211–6. https://doi.org/0.1016/j.diabres.2007.03.010

Burke SD, Sherr D, Lipman RD. Partnering with diabetes educators to improve patient outcomes. Diabetes Metab Syndr Obes 2014;7:45–53. https://doi.org/10.2147/DMSO.S40036

Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med 2002;17(3):243–52. https://doi.org/10.1046/j.1525-1497.2002.10905.x

Quinn CC, Royak SR, Lender D, et al. Patient understanding of diabetes self-management: participatory decision-making in diabetes care. J Diabetes Sci Technol 2011;5(3):723–30. https://doi.org/10.1177/193229681100500327

Ahmann A. Reduction of hospital costs and length of stay by good control of blood glucose levels. Endocr Pract 2004;10(2):53–6. https://doi.org/10.4158/EP.10.S2.53

Huang D, Xie L, Qiu Y. Analysis of factors affecting the length of hospital stay for patients with diabetes. Exp Clin Endocrinol Diabetes 2015; 124(1):5–10. https://doi.org/10.1055/s-0035-1565059

Ashton CM, Del Junco DJ, Souchek J, Wray NP, Mansyur CL. The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence. Med Care 1997;35(10):1044–59. https://doi.org/10.1097/00005650-199710000-00006

Duncan I, Ahmed T, Li QE, et al. Assessing the value of the diabetes educator. Diabetes Educ 2011;37(5):638–57. https://doi.org/10.1177/0145721711416256

Mohebi S, Azadbakht L, Feizi A, Sharifirad G, Kargar M. Review the key role of self-efficacy in diabetes care. J Educ Health Promot 2013;2:36. https://doi.org/10.4103/2277-9531.115827

King P, Peacock I, Donnelly R. The UK Prospective Diabetes Study (UKPDS): clinical and therapeutic implications for type 2 diabetes. Br J Clin Pharmacol 1999;48(5):643–8. https://doi.org/10.1046/j.1365-2125.1999.00092.x

Arifulla M, John LJ, Sreedharan J, et al. Patients’ adherence to anti-diabetic medications in a hospital at Ajman, UAE. Malaysian J Med Sci 2014; 21(1):44–9.

Aminde LN, Tidong M, Ngwasiri CA, et al. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocr Disord 2019;19(1):35. https://doi.org/10.1186/s12902-019-0360-9

Hajat C, Stein E. The global burden of mulriple chronic conditions: a narrative review. Prev Med Rep 2018;12:284–93. https://doi.org/10.1016/j.pmedr.2018.10.008

Szerszen A, Seminara DP, Castellanos MR. Glucose control in the hospitalised elderly - a concern not just for patients with diabetes. Geriatrics 2009;64(6):18–20.

Gerard SO, Ritchie J. Challenges of inpatient glycemic control. J Nurs Care Qual 2017;32(3):267–71. https://doi.org/10.1097/NCQ.0000000000000257

McHugh MD, Shang J, Sloane DM, Aiken LH. Risk factors for hospital-acquired "poor glycemic control": a case-control study. Int J Qual Health Care 2011;23(1):44–51. https://doi.org/10.1093/intqhc/mzq067

Newton CA, Young S. Financial implications of glycemic control: results of an inpatient diabetes management program. Endocr Pract 2006;12(3):43–8. https://doi.org/10.4158/EP.12.S3.43

Daly S, Campbell DA, Cameron PA. Short-stay units and observation medicine: a systematic review. Med J Aust 2003;178(11):559–63.

Levetan CS, Passaro M, Jablonski K, Kass M, Ratner RE. Unrecognized diabetes among hospitalized patients. Diabetes Care 1998;21(2):246–9. https://doi.org/10.2337/diacare.21.2.246

Roman SH, Chassin MR. Windows of Opportunity to improve diabetes care when patients with diabetes are hospitalised for other conditions. Diabetes Care 2001;24(8):1371–6. https://doi.org/10.2337/diacare.24.8.1371

Beagley L. Education patients: understanding barriers, learning styles, and teaching techniques. J Perianesth Nurs 2011;26(5):331–7. https://doi.org/10.1016/j.jopan.2011.06.002

Nettles AT. Patient education in the hospital. Diabetes Spectr 2005;18(1): 4–48. https://doi.org/10.2337/diaspect.18.1.44




DOI: https://doi.org/10.15277/bjd.2020.256

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