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Transitioning Between Settings

Hospital admission is one of the most costly events in our health care system. As a result, there is a large focus on prevention of admissions and readmissions to hospitals. Admissions to hospitals for diabetes are considered largely preventable by many payers and are being measured under the Ambulatory Care Sensitive Conditions Program (PDF, 606 KB). Health systems that are more tightly integrated and have attributes of excellent care coordination may see lower rates of hospital admissions for diabetes. Patients are less likely to be exposed to harm and cost in those systems.

Teach It

Use slides from the American Association of Clinical Endocrinologists Inpatient Glycemic Control Resource Center for a presentation called “Strategies for Effective Discharge Planning for Hospitalized Patients With Diabetes."

Patients who have been hospitalized are at risk for readmission when their care is not coordinated, they are not properly educated, there is lack of attention to medication reconciliation and medication management, and there is lack of planning for subsequent patient-centered care. There is emerging research about how to decrease the likelihood for hospital readmissions. Many of these programs and efforts can be found on the Centers for Medicare & Medicaid Services website.

Patients with diabetes are at great risk for readmission to hospitals, and general efforts at readmission reduction should be applied to them. Specific processes, such as increasing use of diabetes educators, have been associated with a reduction of hospital readmissions.1,2,3

References

1. 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.
2. Saccomano SJ. Taking steps in the hospital to prevent diabetes-related readmissions. Am Nurse Today. 2014;9(4).

3. Magee MF, Khan NH, Desale S, Nassar CM. Diabetes to Go: Knowledge- and competency-based hospital survival skills diabetes education program improves postdischarge medication adherence. Diabetes Educ. 2014;40(3):344-50.

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