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Readmission Rates in Patients With vs Without Diabetes Mellitus at an Urban Teaching Hospital
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In this large, retrospective analysis, the authors evaluated the association between diabetes mellitus (DM) and 30-day hospital readmission rates. After adjusting for age and gender, the authors determined that both primary and secondary DM diagnosis predicted readmission. While the length of stay also predicted readmission, this correlation was not specific to patients with DM.
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The authors concluded that DM increases the risk for hospital readmission regardless of whether DM is a primary or secondary diagnosis.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
We examined the 30-day hospital readmission rates and their association with the admission diagnosis and the length of stay (LOS) in patients with diabetes versus those without diabetes mellitus (DM) in an urban teaching hospital.
METHODS
In this retrospective study, we compared the 30-day readmission rates in patients with DM (n=16,266) versus those without DM (n=86,428) at an urban teaching hospital between January 1, 2013, and September 30, 2015. In individuals with a secondary diagnosis of DM, we analyzed the relationship between readmission rates and the ten most common Medicare Severity Diagnosis Related Groups (MS-DRGs). Additionally, we examined the relationship between the LOS and readmission rates in patients with diabetes and those without DM.
RESULTS
The 30-day readmission rates adjusted for age and gender were higher in patients with DM compared to those without DM (15.3% vs. 8.4%, respectively, <0.001). The increased risk of readmissions was present both in patients with a primary or a secondary diagnosis of DM. For the secondary diagnosis of DM, statistically significant difference was present for two out of the ten most common DRGs (DRG # 313 [chest pain], and # 392 [esophagitis, gastroenteritis, and miscellaneous digestive disorders], p=0.045 and 0.009, respectively). There was a direct correlation between LOS and readmission rates in both patients with diabetes and those without DM (p<0.001 for both).
CONCLUSIONS
The 30-day readmission rates are higher in patients with DM compared to patients without DM. DM is an independent risk factor for hospital readmissions. The readmission rates correlate directly with LOS in both patients with diabetes and those without DM.
Additional Info
Disclosure statements are available on the authors' profiles:
The Readmission Rates in Patients With Versus Those Without Diabetes Mellitus at an Urban Teaching Hospital
J Diabetes Complicat 2017 Dec 01;31(12)1681-1685, H Sonmez, V Kambo, D Avtanski, L Lutsky, L PoretskyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study adds to the growing evidence that patients with diabetes are at higher risk for readmission than those without diabetes. This may be the first to suggest that type 1 diabetes bears a higher risk of readmission than type 2, which is not surprising given the generally greater medical complexity of hospitalized type 1 patients. This conclusion, however, should be viewed with caution, as retrospectively classifying diabetes type based on ICD9 codes may be inaccurate. The readmission rates reported are probably underestimates because high-risk individuals (those with psychiatry and chemical dependence DRGs) were excluded, and readmissions at other institutions, which likely occurred near this Manhattan-based hospital, were not captured. The underreporting, however, is probably not different between diabetes and non-diabetes patients.
The observation that diabetes is associated with higher readmission risk for patients hospitalized with chest pain and GI issues is interesting, but would need to be confirmed to conclude that diabetes increases the risk of readmission for these patients. Lastly, the association of LOS with readmission risk has been documented in many studies of patients with and without diabetes. LOS almost certainly reflects severity of illness and is therefore related to readmission risk. The authors’ call for more studies to derive stronger conclusions about factors that affect readmission risk and measures that may reduce that risk in patients with diabetes is timely.