Seggelke Stacey A, Hawkins R Mathew, Gibbs Joanna, Rasouli Neda, Wang Cecilia, Draznin Boris
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
Hosp Pract (1995). 2014 Feb;42(1):46-51. doi: 10.3810/hp.2014.02.1091.
Transitioning from the inpatient to outpatient setting is often a problematic aspect of diabetes mellitus (DM) care. Different factors during hospitalization may adversely affect glycemic control in patients, who are frequently discharged on regimens that differ markedly from prehospitalization outpatient regimens. Moreover, the discharge recommendations may not have been tested adequately during a relatively short hospital length of stay and pose a significant threat to patient safety upon discharge. Our pilot study evaluated the effect on hospital utilization of the transitional care clinic (TCC), where patients with DM are seen within 2 to 5 days of hospital discharge. One hundred patients with DM, who were either medically indigent (no insurance or Medicaid and no primary care providers) or covered by Medicaid, and who did not have a primary care provider, were randomized into either a control or an intervention group upon discharge from the hospital. Subjects from the intervention group (n = 50) were seen in the TCC. All subjects were contacted 90 days after discharge to collect information about emergency department visits and readmissions. Thirteen subjects from the control group and 13 from the intervention group visited the emergency department within 90 days of discharge. Fourteen control subjects (28%) and 10 intervention patients (20%) were rehospitalized for various medical conditions during the follow-up period (P = not significant). Among patients originally admitted for DM-related issues, 6 of 14 in the control group (42.9%) and 2 out of 16 in the intervention group (12.5%) were readmitted during follow-up (P < 0.05). We conclude that the TCC may be effective for the prevention of rehospitalizations in indigent patients admitted for DM-related problems and who did not have primary care providers. The benefit of the TCC was not seen when patients with DM were admitted for other medical problems. Larger randomized controlled trials are needed to confirm this preliminary finding.
从住院环境过渡到门诊环境通常是糖尿病（DM）护理中一个存在问题的方面。住院期间的不同因素可能会对患者的血糖控制产生不利影响，患者出院时所采用的治疗方案往往与住院前的门诊治疗方案有显著差异。此外，出院建议在相对较短的住院时间内可能没有得到充分检验，并且在出院时对患者安全构成重大威胁。我们的试点研究评估了过渡护理诊所（TCC）对医院利用率的影响，在该诊所，糖尿病患者在出院后2至5天内接受诊治。100名糖尿病患者，他们要么是医疗贫困者（没有保险或医疗补助且没有初级保健提供者），要么由医疗补助覆盖且没有初级保健提供者，在出院时被随机分为对照组或干预组。干预组的50名受试者在TCC接受诊治。所有受试者在出院90天后被联系，以收集有关急诊科就诊和再入院的信息。对照组的13名受试者和干预组的13名受试者在出院后90天内去过急诊科。在随访期间，14名对照组受试者（28%）和10名干预组患者（20%）因各种医疗状况再次住院（P值无统计学意义）。在最初因糖尿病相关问题入院的患者中，对照组14人中有6人（42.9%）在随访期间再次入院，干预组16人中有2人（12.5%）再次入院（P<0.05）。我们得出结论，TCC可能对预防因糖尿病相关问题入院且没有初级保健提供者的贫困患者再次住院有效。当糖尿病患者因其他医疗问题入院时，未观察到TCC的益处。需要更大规模的随机对照试验来证实这一初步发现。
