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In-Hospital Interventions and Reduced Length of Hospital Stay and Readmission of T2D Patients
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This review assessed the effectiveness of various in-hospital interventions in type 2 diabetes (T2D) patients in terms of hospital readmission, length of hospital stay, and HbA1c levels. A dedicated care team, hospital-wide approach, quality-improvement focus, insulin therapy, an early short-term intensive program, transition to primary care physicians, and ongoing outpatient follow-up for at least 6 to 12 months were some of the interventions used in the studies that were reviewed. A reduction in hospital stay of 0.5 to 0.8 days and a mean reduction in HbA1c of -1.1 (±2.2) mmol/L to -2.8 (±2.7) mmol/L were seen.
- Multifaceted hospital interventions for T2D patients can improve length of hospital stay and HbA1c concentration.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersAIM
This review aimed to assess the effectiveness of multifaceted in-hospital interventions for patients with type 2 diabetes mellitus on hospital readmission, hospital length of stay (LOS), and glycated haemoglobin (HbA1c).
METHODS
The search included MEDLINE, EMBASE, Emcare, Web of Science, PsycINFO and Google Scholar from 2007 to current date and restricted to English. The differences in outcome measures were calculated to determine the effectiveness.
RESULTS
The title and abstract of 3251 records were initially screened. Nine studies met the inclusion criteria. Most studies comprised of a wide range of intervention components and outcome measures. The reduction in hospital LOS ranged from 0.5 to 0.8 of a day. Clinically significant improvements in HbA1c concentration levels ranged from a mean reduction of -1.1 (±2.2) mmol/L to -2.8 (±2.7) mmol/L. There were no significant changes in hospital readmission rates and no evidence of the impact of HbA1c on hospital LOS and readmission. Common strategies in reducing hospital LOS and HbA1c were a dedicated care team, hospital wide approach, quality improvement focus, insulin therapy, early short-term intensive program, transition to primary care physicians, and on-going outpatient follow-up for at least 6-12 months.
CONCLUSIONS
The findings illustrate that multifaceted in-hospital intervention for patients diagnosed with type 2 diabetes can contribute to improvements in hospital LOS and HbA1c concentration.
Additional Info
Disclosure statements are available on the authors' profiles:
The Effectiveness of In-Hospital Interventions on Reducing Hospital Length of Stay and Readmission of Patients With Type 2 Diabetes Mellitus: A Systematic Review
Diabetes Res. Clin. Pract. 2020 Aug 06;[EPub Ahead of Print], A Chakraborty, O Pearson, KM Schwartzkopff, I O'rourke, I Ranasinghe, P Mann Mah, R Adams, M Boyd, G WittertFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This systematic review aimed to assess the effectiveness of multifaceted interventions begun in the hospital for patients with type 2 diabetes on hospital LOS, readmission within 12 months, and HbA1c. The systematic review was registered and rigorously performed on published literature since 2007. Only nine papers were identified, of which two were RCTs that included a total of 116 patients. Heterogeneity of the studies precluded meta-analysis and a clear conclusion related to LOS and readmission. Nonetheless, the authors reported a reduction in LOS ranging from 0.5 to 0.8 days. Only three studies reported readmission as an outcome, with no effect. Reductions in HbA1c ranged from −1.1 to −2.8 mmol/L at up to 12 months after intervention. Notably, three of the studies assessed elective inpatient interventions ranging from 5 to 30 days in duration and thus do not generalize to the typical unplanned hospitalization. Not included was a recently published RCT that showed outpatient follow-up in a diabetes clinic reduced readmissions or ED visits at 1 year by 63%.1
This paper is important in that it brings attention to the potential benefits of interventions begun in the hospital for diabetes patients as well as the substantial gaps in knowledge and weaknesses of the current literature. There are no interventional studies addressing psychosocial factors or social determinants of health, which are established risk factors for readmission.2,3 Studies also lack representation of racial/ethnic minorities. Most papers fail to report the theoretical underpinning of the design and implementation of the interventions. As noted, the use of historical controls can overestimate the effectiveness of treatments. Thus, RCTs are sorely needed to clarify the effects of various in- and out-of-hospital interventions on these important outcomes in patients with diabetes.
References